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Washington 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
$277.63 / $277.63 / $277.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.26 / $277.63 / $317.18
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.24 / $529.41 / $1,559.56
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.31 / $283.25 / $325.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $153.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.00 / $281.00 / $281.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.43 / $325.43 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.79 / $507.49 / $824.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.43 / $325.43 / $586.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.60 / $496.32 / $943.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.25 / $283.25 / $283.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.42 / $360.84 / $820.11