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Kansas 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
$293.49 / $293.49 / $386.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.49 / $386.17 / $386.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.39 / $312.83 / $331.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.52 / $310.52 / $310.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.88 / $350.62 / $1,898.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $317.36 / $450.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $298.19 / $518.30