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Texas rates for HCPCS B4157

Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.54 / $5.54 / $5.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $8.16
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $4.90 / $4.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $2.06 / $4.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $8.16 / $8.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $4.90
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $5.63