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Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$2,115.66 / $2,115.66 / $2,564.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.66 / $2,340.04 / $10,562.30
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
$73.59 / $3,660.81 / $3,660.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,115.66 / $2,115.66 / $2,564.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.66 / $2,340.04 / $10,562.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,617.32 / $3,484.42 / $3,484.42
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,617.32 / $3,484.42 / $3,484.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.34 / $2,920.62 / $5,159.43