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South Carolina rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.52 / $1.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $2.04 / $2.56
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.59 / $1.80 / $3.73
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.57 / $1.44 / $2.44