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Washington rates for HCPCS B4149

Enteral Formula Manufactured Blendarized Natural Foods With Intact Nutrients Includes Proteins Fats Carbohydrates Vitamins And Minerals May Include Fiber Administered Through An Enteralfeeding Tube 100 Calories=1 Unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $1.22 / $1.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $1.22 / $1.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $2.33 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.26 / $1.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.70 / $1.70
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.27 / $1.30 / $1.70
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $2.02 / $3.28
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $2.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $2.00 / $3.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $2.17 / $3.49