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New Hampshire rates for HCPCS B4159

Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.40 / $0.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $2.08 / $2.60