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Washington rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.47 / $0.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.68 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.45 / $0.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.47 / $0.70
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.72 / $1.17
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.66 / $0.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.93 / $1.30