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Louisiana rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.36 / $1.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $8.16