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Arkansas rates for HCPCS B4197

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 74 To 100 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
$326.82 / $326.82 / $326.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.94 / $326.82 / $338.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179,999.82 / $489,999.51 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.56 / $391.18 / $391.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $297.62 / $399.01