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Illinois rates for HCPCS B4189

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 10 To 51 Grams Of Protein - Premix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.48 / $245.48 / $245.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.40 / $210.57 / $245.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.85 / $523.54 / $2,881.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.32 / $257.89 / $257.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.00 / $119.00 / $119.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $296.58 / $517.71
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.27 / $335.27 / $335.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.66 / $212.26 / $462.36