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New Mexico 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
$0.73 / $0.73 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $4.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $4.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $5.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72