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Wisconsin rates for HCPCS B4176

Parenteral Nutrition Solution; Amino Acid 7% Through 8.5% (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
$50.99 / $50.99 / $50.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.34 / $50.99 / $200.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.56 / $69.56 / $114.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.70 / $64.70 / $76.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.61 / $148.88 / $148.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.53 / $217.98 / $334.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.91 / $100.78 / $131.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.34 / $69.56 / $73.05
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.85 / $24.85 / $24.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.99 / $69.56 / $325.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.70 / $78.66 / $211.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.34 / $69.56 / $73.05
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.85 / $24.85 / $24.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $104.95 / $207.77
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.88 / $141.22 / $325.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.91 / $56.91 / $56.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $69.56 / $69.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $69.56 / $69.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.18 / $69.56 / $211.24