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South Carolina rates for HCPCS B4162

Enternal Formula For Pediatrics Special Metabolic Needs For Inherited Disease

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 / $2.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.67 / $3.67 / $3.67
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