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Pennsylvania rates for HCPCS B5100

Parenteral Nutrition Solution Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Anystrength Hepatic Hepatamine-Premix (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $3.89 / $4.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $4.30 / $19.43
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
$6.74 / $6.74 / $6.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $5.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $3.89 / $4.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $4.30 / $19.43
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $5.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.82 / $6.41 / $6.41
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $6.41 / $6.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.36 / $5.32 / $8.86