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Montana rates for HCPCS B4164

Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit), home mix

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