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Utah rates for HCPCS B4164

Parenteral Nutrition Solution: Carbohydrates (Dextrose) 50% Or Less (500 Ml = 1 Unit) - Homemix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $20.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.83 / $35.22 / $36.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $21.08 / $30.31