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New Hampshire rates for HCPCS B4162

Enternal Formula For Pediatrics Special Metabolic Needs For Inherited Disease

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.57 / $0.72 / $0.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $4.15 / $5.19