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Vermont 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
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $1.92 / $2.47
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $1.92 / $1.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $2.68 / $2.84