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Vermont rates for HCPCS B4155

Enteral Formula Nutritionally Incomplete/Modular Nutients Includes Specific Calories = 1 Unit (Special Coverage Instructions A

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $5.92
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $1.33 / $1.42