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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 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
$291.79 / $961.47 / $961.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.43 / $325.43 / $325.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.90 / $349.90 / $349.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.90 / $349.90 / $349.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.90 / $349.90 / $349.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.15 / $262.61 / $317.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.84 / $429.94 / $491.36