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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$167.52 / $167.52 / $386.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.61 / $774.77 / $917.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.00 / $318.57 / $519.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $284.63 / $480.24