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Maine 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
$176.77 / $208.15 / $208.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.63 / $534.21 / $615.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.16 / $226.16 / $226.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $208.25 / $208.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.24 / $417.24 / $499.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.77 / $208.15 / $208.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.59 / $495.19 / $586.90