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South Carolina rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $6.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.20 / $6.20 / $6.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.80 / $0.92
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00