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Texas rates for HCPCS B4197

Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 g of protein - premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.05 / $344.60 / $355.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.33 / $351.71 / $383.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.19 / $284.19 / $284.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$681.61 / $1,898.77 / $1,927.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.16 / $341.05 / $492.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.15 / $204.40 / $405.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.66 / $343.28 / $502.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.15 / $170.00 / $369.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.76 / $311.89 / $411.69
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.72 / $405.72 / $547.72