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West 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
$170.52 / $170.52 / $170.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.52 / $250.76 / $386.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.73 / $518.20 / $608.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.23 / $782.23 / $782.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.45 / $475.45 / $475.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $1,955.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.41 / $303.62 / $568.01