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Louisiana 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 g of protein, premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $275.42 / $316.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $218.78 / $302.00