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Virginia 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
$250.76 / $250.76 / $386.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.66 / $250.76 / $386.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.72 / $405.72 / $430.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.21 / $396.21 / $396.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $170.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.03 / $474.69 / $600.47
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.05 / $267.47 / $420.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.12 / $152.12 / $205.85
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.04 / $380.74 / $9,929.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.04 / $380.74 / $9,929.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.18 / $319.41 / $563.37