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South Carolina rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $1.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.06 / $2.06
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.45 / $0.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40