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Wisconsin rates for HCPCS B4224

Parenteral Nutrition Administration Kit 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
$26.58 / $26.58 / $26.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $26.58 / $104.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.27 / $36.27 / $59.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.72 / $33.72 / $39.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.64 / $32.64 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.32 / $113.73 / $174.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.60 / $52.50 / $68.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $36.27 / $38.08
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $13.10 / $13.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.58 / $36.27 / $169.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.10 / $41.02 / $110.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $36.27 / $38.08
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $13.10 / $13.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.27 / $54.76 / $108.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.84 / $73.63 / $169.74
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.60 / $21.60 / $21.60
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.27 / $36.27 / $36.27
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.45 / $32.45 / $32.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.27 / $36.27 / $36.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.17 / $36.27 / $110.15