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Illinois rates for HCPCS B4199

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 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
$441.26 / $441.26 / $441.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.52 / $378.52 / $441.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.52 / $939.56 / $5,180.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.88 / $463.60 / $463.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $208.25 / $208.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.76 / $463.60 / $649.04
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.67 / $602.67 / $602.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$463.60 / $463.60 / $463.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.28 / $356.24 / $649.52