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Montana rates for HCPCS B4189

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 10 To 51 Grams Of Protein - Premix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.83 / $744.11 / $744.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.86 / $251.86 / $251.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.80 / $270.80 / $270.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.80 / $270.80 / $270.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.80 / $270.80 / $270.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.28 / $203.25 / $245.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.27 / $344.63 / $670.07