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Wisconsin rates for HCPCS B4216

Parenteral Nutrition; Additives (Vitamins Trace Elements Heparin Electrolytes) Homemix Per Day (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.21 / $8.21 / $8.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.78 / $8.21 / $32.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.20 / $11.20 / $18.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.42 / $10.42 / $12.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.08 / $23.97 / $23.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.74 / $34.75 / $53.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $16.41 / $21.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.78 / $11.20 / $11.76
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.21 / $11.20 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.59 / $12.66 / $34.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.78 / $11.20 / $11.76
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.20 / $16.80 / $33.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $22.74 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $5.09 / $5.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.20 / $11.20 / $11.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.20 / $11.20 / $11.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $11.20 / $34.00