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New Hampshire rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.12 / $1.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $1.87 / $2.20
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
$2.75 / $3.65 / $4.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $6.05