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South Carolina rates for HCPCS B4193

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 52 To 73 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
$317.18 / $317.18 / $317.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.28 / $291.79 / $317.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.44 / $333.24 / $401.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.56 / $317.18 / $428.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.37 / $132.37 / $132.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.31 / $250.44 / $315.80