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New Hampshire rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.57 / $0.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.85 / $0.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.14 / $1.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.49 / $1.78