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Pennsylvania rates for HCPCS B4180

Parenteral Nutrition Solution; Carbohydrates (Dextrose) Greater Than 50% (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
$20.45 / $20.45 / $24.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.88 / $22.62 / $102.12
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
$35.40 / $35.40 / $35.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.45 / $20.45 / $24.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.88 / $22.62 / $102.12
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.30 / $33.69 / $33.69
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.30 / $33.69 / $33.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $27.96 / $50.72