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Pennsylvania rates for HCPCS B4199

Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 g of protein - premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $338.84 / $602.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $467.74 / $467.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $323.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $323.59 / $436.52
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $331.13 / $436.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $331.13 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $363.08 / $616.60