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Montana rates for HCPCS B9004

Parenteral Nutrition Infusion Pump Portable (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,205.54 / $10,562.30 / $10,562.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.92 / $565.92 / $565.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,843.85 / $3,843.85 / $3,843.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,843.85 / $3,843.85 / $3,843.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,843.85 / $3,843.85 / $3,843.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,843.85 / $3,843.85 / $4,290.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,964.10 / $4,775.07 / $5,397.93