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Montana rates for HCPCS B4187

Omegaven, 10 g lipids

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.27 / $14.27 / $14.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.10 / $17.10 / $17.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.10 / $17.10 / $17.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.10 / $17.10 / $17.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.84 / $12.84 / $114.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.16 / $21.78 / $24.03