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South Carolina rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.50 / $0.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.70 / $0.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.63 / $1.17
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.47 / $0.88