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Wisconsin rates for HCPCS B4220

Parenteral Nutrition Supply Kit; Premix 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
$8.51 / $8.51 / $8.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.07 / $8.51 / $33.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.61 / $11.61 / $19.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.80 / $10.80 / $12.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.45 / $10.45 / $24.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.54 / $36.86 / $56.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $16.88 / $21.98
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $11.61 / $12.19
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.26 / $4.26 / $4.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $11.61 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.80 / $13.14 / $35.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $11.61 / $12.19
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.26 / $4.26 / $4.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.61 / $17.75 / $35.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.68 / $23.57 / $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
$11.61 / $11.61 / $11.61
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.02 / $10.02 / $10.02
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.61 / $11.61 / $11.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.54 / $12.03 / $42.38