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Vermont 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
$164.57 / $164.57 / $164.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.00 / $119.00 / $161.43
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.43 / $161.43 / $161.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.66 / $251.61 / $298.12