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South Carolina rates for HCPCS B4189

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 10 To 51 Grams Of Protein - Premix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.48 / $245.48 / $245.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.32 / $225.83 / $245.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.88 / $257.89 / $322.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.97 / $245.48 / $331.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.44 / $102.44 / $102.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.78 / $193.80 / $261.63