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Maine 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
Professional
Modifier
Low / Median / High Price
$98.34 / $115.80 / $115.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.57 / $297.18 / $342.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.02 / $257.89 / $257.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.00 / $119.00 / $119.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.11 / $232.11 / $278.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.34 / $115.80 / $115.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.36 / $275.48 / $326.50