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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 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
$192.58 / $192.58 / $233.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.06 / $213.01 / $961.47
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.24 / $333.24 / $333.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $153.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.58 / $192.58 / $233.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.06 / $213.01 / $961.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $153.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.26 / $317.18 / $317.18
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.26 / $317.18 / $317.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.25 / $263.23 / $387.91