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New Hampshire rates for HCPCS B4187

Omegaven, 10 Grams Lipids

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $6.57 / $7.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.57 / $7.84 / $7.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.91 / $16.29 / $16.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.89 / $24.41 / $48.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $8.13 / $19.64
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.50 / $106.15 / $135.10