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Indiana 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 / $270.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.20 / $245.48 / $245.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.74 / $230.82 / $257.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.22 / $113.22 / $169.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.94 / $257.89 / $321.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.18 / $263.17 / $298.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.68 / $94.68 / $94.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.44 / $149.44 / $264.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.78 / $201.85 / $309.48