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New Hampshire rates for HCPCS B4197

Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 g of protein - premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.11 / $140.11 / $168.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.11 / $148.79 / $154.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.21 / $432.86 / $480.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.72 / $405.72 / $405.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.15 / $593.00 / $1,202.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.94 / $202.41 / $438.56
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.86 / $318.70 / $481.33