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Montana rates for HCPCS B4164

Parenteral Nutrition Solution: Carbohydrates (Dextrose) 50% Or Less (500 Ml = 1 Unit) - Homemix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.59 / $71.14 / $71.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.89 / $25.89 / $25.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.89 / $25.89 / $25.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.89 / $25.89 / $25.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.43 / $19.43 / $25.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.70 / $32.95 / $36.35