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Idaho 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
$295.18 / $355.26 / $355.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.72 / $355.26 / $508.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.43 / $385.43 / $405.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.48 / $604.16 / $888.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.00 / $284.00 / $405.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.41 / $355.21 / $531.48