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Vermont 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
$258.89 / $258.89 / $258.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $254.16
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.16 / $254.16 / $254.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.34 / $395.84 / $469.02