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Wyoming 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
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.02 / $1.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.38 / $3.55