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Texas rates for HCPCS B4155

Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $1 · 10th–90th $1–$890%20%10th90th$1Professionalmedian $1 · 10th–90th $1–$20%10%20%10th90th$1$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.48 / $2.14
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $0.78 / $0.89
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.66 / $0.66 / $0.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.79 / $0.93 / $17.38
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $0.95 / $1.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $81.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.79 / $0.98 / $19.05
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $5.89 / $5.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.76 / $0.76 / $0.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.62 / $0.93 / $1.38