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Indiana rates for HCPCS B4193

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 52 To 73 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
$317.18 / $317.18 / $349.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.13 / $317.18 / $317.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.26 / $298.25 / $333.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.31 / $146.31 / $219.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.98 / $349.90 / $415.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.77 / $314.98 / $385.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.40 / $102.40 / $102.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.13 / $193.13 / $341.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.83 / $260.82 / $399.89