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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 Grams Of Protein - Premix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.33 / $107.33 / $107.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.33 / $107.33 / $277.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.66 / $473.16 / $487.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.26 / $320.24 / $409.65