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Illinois 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
$386.17 / $386.17 / $386.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.76 / $331.26 / $386.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.90 / $820.70 / $4,533.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.58 / $405.72 / $405.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.82 / $418.20 / $608.58
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.44 / $527.44 / $527.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.41 / $320.48 / $568.42