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New Hampshire rates for HCPCS B4193

Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 g of protein, premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $147.91 / $239.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $354.81 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $457.09 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $165.96 / $363.08