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Pennsylvania rates for HCPCS B4187

Omegaven, 10 g lipids

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.42 / $9.42 / $10.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.55 / $10.42 / $14.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.42 / $9.42 / $9.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.39 / $10.42 / $15.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.91 / $15.51 / $15.51
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.91 / $15.51 / $15.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $13.55 / $21.46