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South Carolina rates for HCPCS B4155

Enteral Formula Nutritionally Incomplete/Modular Nutients Includes Specific Calories = 1 Unit (Special Coverage Instructions A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.92 / $0.92 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.84 / $0.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $1.11 / $1.39
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.92 / $2.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.80 / $1.22