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Utah 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
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $275.42 / $316.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $363.08 / $575.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $912.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $338.84 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $323.59 / $489.78