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Montana rates for HCPCS B4199

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 100 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
$405.94 / $1,337.58 / $1,337.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.73 / $452.73 / $452.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.78 / $486.78 / $486.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.78 / $486.78 / $486.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.78 / $486.78 / $486.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.83 / $365.35 / $441.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.00 / $598.13 / $683.58