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New Hampshire rates for HCPCS B4180

Parenteral Nutrition Solution; Carbohydrates (Dextrose) Greater Than 50% (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
$12.22 / $12.22 / $14.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.22 / $12.98 / $13.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.21 / $37.77 / $41.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.40 / $35.40 / $35.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.86 / $51.74 / $104.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.86 / $17.66 / $38.26
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.80 / $26.18 / $33.32