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Washington rates for HCPCS B4164

Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit), home mix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.54 / $20.54 / $20.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.12 / $20.54 / $23.47
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.66 / $43.18 / $115.41
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.59 / $20.96 / $24.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $20.35 / $20.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.77 / $20.77 / $20.77
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.08 / $24.08 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.59 / $37.54 / $61.02
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.08 / $24.08 / $43.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.79 / $36.95 / $70.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.96 / $20.96 / $20.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.15 / $26.15 / $60.68