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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
$1.00 / $1.00 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $2.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.51
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
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.62 / $1.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.95 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.62 / $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
$2.14 / $2.14 / $2.69