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Washington 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
$3,049.99 / $3,049.99 / $3,049.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,650.67 / $3,049.99 / $3,484.42
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,205.54 / $5,709.19 / $11,993.29
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,868.89 / $1,868.89 / $2,651.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.83 / $488.68 / $3,087.02
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,575.01 / $3,575.01 / $79,999.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,575.01 / $3,575.01 / $3,660.81
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.44 / $5,112.26 / $8,462.04
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.44 / $3,575.01 / $3,575.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,542.91 / $5,451.50 / $10,357.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,373.71 / $4,042.76 / $9,927.67