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Utah 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 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
$130.66 / $130.66 / $130.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.66 / $130.66 / $338.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.26 / $575.98 / $593.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.73 / $346.73 / $498.75