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Louisiana 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
$1.31 / $1.37 / $1.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.44 / $1.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.43 / $1.43
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.31 / $665.31 / $665.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.55 / $2.44