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Nebraska 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
$281.89 / $386.17 / $1,170.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.85 / $1,837.24 / $3,839.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.39 / $392.25 / $396.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.14 / $470.25 / $587.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.47 / $521.33 / $1,898.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.47 / $337.35 / $689.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.99 / $506.53 / $557.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.00 / $506.53 / $852.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.47 / $337.35 / $518.30