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Wisconsin 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
$2,683.00 / $2,683.00 / $2,683.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.63 / $2,683.00 / $10,562.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,795.10 / $5,795.10 / $9,561.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,404.55 / $5,012.17 / $5,795.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.55 / $1,240.15 / $7,834.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,838.43 / $11,496.98 / $17,636.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $4,371.18 / $5,304.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,543.63 / $3,660.81 / $3,843.85
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.65 / $1,313.65 / $1,313.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,543.63 / $3,660.81 / $17,132.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.34 / $4,139.70 / $11,116.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,543.63 / $3,660.81 / $3,843.85
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.65 / $1,313.65 / $1,313.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.36 / $1,332.81 / $1,900.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $7,431.44 / $17,132.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.81 / $3,660.81 / $3,660.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.81 / $3,660.81 / $3,660.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,430.00 / $3,234.21 / $11,116.93