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Massachusetts rates for HCPCS B4164

Parenteral Nutrition Solution: Carbohydrates (Dextrose) 50% Or Less (500 Ml = 1 Unit) - Homemix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.40 / $9.40 / $9.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.40 / $9.40 / $15.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.47 / $25.28 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $21.80 / $27.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.21 / $47.44 / $105.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $37.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $20.35 / $20.35
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $3,504.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.19 / $22.19 / $46.08
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.06 / $100.00 / $117.14
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.54 / $16.78 / $34.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $15.82 / $34.13