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South Carolina rates for HCPCS B4197

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 74 To 100 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
$386.17 / $386.17 / $386.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.49 / $355.26 / $386.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.89 / $405.72 / $488.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.83 / $386.17 / $521.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.15 / $161.15 / $161.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.38 / $314.39 / $411.60