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Maine 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 g of protein - premix

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $182.17 / $182.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.62 / $467.51 / $538.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.62 / $405.72 / $405.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.15 / $365.15 / $437.49
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $182.17 / $182.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.05 / $449.41 / $513.62