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Mississippi rates for HCPCS B4193

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 52 To 73 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
$291.79 / $291.79 / $291.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.07 / $291.79 / $291.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.14 / $271.14 / $298.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.24 / $258.24 / $258.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $153.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.83 / $277.08 / $373.16