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New Hampshire rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.85 / $1.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.90 / $0.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $1.50 / $1.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.28 / $1.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $3.30 / $4.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.83 / $2.59