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New Hampshire rates for HCPCS B4199

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 100 Grams Of Protein - Premix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.10 / $160.10 / $192.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.10 / $170.02 / $176.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.88 / $494.61 / $549.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.16 / $226.16 / $226.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $208.25 / $208.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.24 / $677.60 / $1,374.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $231.28 / $501.11
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.79 / $364.17 / $550.00