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New Hampshire rates for HCPCS B4164

Parenteral Nutrition Solution: Carbohydrates (Dextrose) 50% Or Less (500 Ml = 1 Unit) - Homemix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $8.51 / $10.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $9.03 / $9.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.44 / $26.31 / $29.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.66 / $24.66 / $24.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $20.35 / $20.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.19 / $36.04 / $73.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.49 / $12.30 / $25.95
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $18.23 / $23.21