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New Hampshire rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes 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
$1.12 / $1.12 / $1.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.12 / $3.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.07 / $4.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $6.03