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New Hampshire rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.32 / $0.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.49 / $0.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.40 / $0.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.96 / $1.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.28 / $0.98