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Missouri 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
$241.06 / $275.95 / $317.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.06 / $275.95 / $317.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.24 / $349.90 / $1,538.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.31 / $148.34 / $309.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $390.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.73 / $676.48 / $1,559.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.77 / $210.42 / $388.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.87 / $200.35 / $508.03