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Oklahoma 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
$337.50 / $337.50 / $337.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.50 / $337.50 / $355.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.26 / $355.26 / $355.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.77 / $373.02 / $823.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $289.70 / $404.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $289.70 / $404.06