| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
HMSA
| Professional | $1.26 | $1.26 | $1.26 | |
United
| Professional | $1.35 | $1.51 | $1.70 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
HMSA
| Professional | $1.26 | $1.26 | $1.26 | |
United
| Professional | $1.35 | $1.51 | $1.70 |