go back

New Hampshire rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and 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
$0.25 / $0.25 / $0.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.25 / $0.26 / $0.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.42 / $0.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.33 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.65 / $0.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.23 / $0.81