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Alabama rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $1.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $2.57 / $2.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.44 / $2.54