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Texas rates for HCPCS B4158

Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $100 · 10th–90th $1–$1000%50%10th$100Professionalmedian $1 · 10th–90th $1–$10%50%90th$1$0.5$2.0$10.0$50.0

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 / $1.00 / $1.00
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.05 / $1.15 / $1.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $0.52
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $0.59 / $1.78
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.40 / $1.00 / $2.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.91 / $1.29 / $81.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $0.59 / $1.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.40 / $0.52 / $0.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.66
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.45