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Arizona 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
Professional
Modifier
Low / Median / High Price
$227.20 / $227.20 / $1,170.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.89 / $1,197.07 / $1,994.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.39 / $370.02 / $737.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.76 / $405.72 / $1,898.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.81 / $308.47 / $507.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.83 / $320.20 / $507.21