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Michigan 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
Facility
Modifier
Low / Median / High Price
$386.17 / $386.17 / $545.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.76 / $386.17 / $386.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.59 / $1,140.44 / $2,203.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.43 / $405.72 / $405.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.25 / $139.25 / $252.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.85 / $315.85 / $386.17
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.85 / $355.26 / $475.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.13 / $160.13 / $160.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.41 / $311.89 / $503.07