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Georgia 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
$1.41 / $1.41 / $2.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.44 / $1.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $2.42 / $5.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.28 / $3.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.42 / $2.60 / $5.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $9.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.66 / $98.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $2.29 / $3.15