go back

Montana rates for HCPCS B4193

Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 g of protein, premix

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $275.42 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $562.34 / $575.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $562.34 / $575.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $263.03 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $426.58 / $489.78