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Pennsylvania rates for HCPCS B4220

Parenteral nutrition supply kit; premix, per day

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.94 / $15.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.76 / $11.75
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $7.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.94 / $10.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $8.32 / $10.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $8.32 / $10.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $9.12 / $15.14