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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 g of protein, premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $275.42 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $75.86 / $281.84
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $331.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $489.78 / $707.95
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $501.19 / $933.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $354.81 / $831.76
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $512.86