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Pennsylvania 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
$190.55 / $190.55 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $239.88 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $234.42 / $338.84
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $234.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $234.42 / $316.23
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $239.88 / $316.23
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $239.88 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $263.03 / $436.52