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South Carolina rates for HCPCS B4159

Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact

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 / $1.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.38
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