go back

Utah 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
$149.31 / $149.31 / $149.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.31 / $149.31 / $386.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.41 / $658.33 / $678.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.64 / $384.51 / $569.89