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Texas rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes 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
$1.13 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.42 / $2.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
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
$1.13 / $3.24 / $3.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $2.39 / $3.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.74 / $1.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $1.87 / $3.11