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Texas 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
$280.12 / $283.04 / $291.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.01 / $288.87 / $315.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.42 / $233.42 / $233.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $153.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.84 / $1,559.56 / $1,582.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.11 / $280.12 / $404.75
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.37 / $167.67 / $333.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.38 / $282.02 / $413.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.37 / $153.00 / $303.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.26 / $249.37 / $338.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.24 / $333.24 / $449.87