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Texas rates for HCPCS B4160

Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, 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
$0.34 / $0.34 / $0.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
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
$0.34 / $1.07 / $1.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.87 / $1.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.42 / $0.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $1.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.11 / $1.19