go back

Arizona 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
Professional
Modifier
Low / Median / High Price
$259.62 / $259.62 / $1,337.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.40 / $1,367.91 / $2,279.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.68 / $422.80 / $842.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $208.25 / $208.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.15 / $463.60 / $2,169.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.74 / $352.47 / $579.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.92 / $352.47 / $627.26