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Pennsylvania rates for HCPCS B4164

Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit), home mix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.25 / $14.25 / $17.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.36 / $15.76 / $71.14
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.66 / $24.66 / $24.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $20.35 / $20.35
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.25 / $14.25 / $17.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.36 / $15.76 / $71.14
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $20.35 / $20.35
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.62 / $23.47 / $23.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.62 / $23.47 / $23.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $19.67 / $28.70