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West Virginia 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
Professional
Modifier
Low / Median / High Price
$3.16 / $3.16 / $3.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $4.07 / $4.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.10 / $1.78