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South Carolina rates for HCPCS B4199

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 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
$441.26 / $441.26 / $441.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.80 / $405.94 / $441.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.40 / $463.60 / $557.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.04 / $441.26 / $595.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.14 / $184.14 / $184.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.41 / $365.82 / $439.33