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Indiana rates for HCPCS B4164

Parenteral Nutrition Solution: Carbohydrates (Dextrose) 50% Or Less (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
$23.47 / $23.47 / $25.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.81 / $23.47 / $23.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.48 / $22.07 / $24.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.59 / $10.59 / $16.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.76 / $24.66 / $30.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.57 / $25.33 / $28.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.80 / $19.80 / $19.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.98 / $13.98 / $25.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $19.46 / $29.59