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Texas 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
$389.70 / $393.76 / $405.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.33 / $401.88 / $438.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.73 / $324.73 / $324.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $208.25 / $208.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$778.85 / $2,169.65 / $2,202.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.77 / $389.70 / $563.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.14 / $233.31 / $463.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.23 / $392.40 / $574.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.14 / $208.25 / $422.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.11 / $346.92 / $470.44
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.16 / $226.16 / $625.86