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Montana rates for HCPCS B4176

Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.92 / $200.71 / $200.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.05 / $73.05 / $73.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.05 / $73.05 / $73.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.05 / $73.05 / $73.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.83 / $54.83 / $73.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $89.75 / $102.57