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Texas rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

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