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Montana rates for HCPCS B4197

Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 g of protein - premix

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.26 / $1,170.59 / $1,170.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.21 / $396.21 / $396.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.01 / $426.01 / $426.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.01 / $426.01 / $426.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.01 / $426.01 / $426.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.91 / $319.73 / $386.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.33 / $523.46 / $598.24