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Utah rates for HCPCS B4154

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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.59 / $0.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $0.96 / $1.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $1.12 / $1.55