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Washington rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $0.82 / $0.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.82 / $0.96
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.34 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.78 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.33
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.84 / $2.12
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $1.21 / $2.02
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.78 / $1.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.28 / $1.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.69 / $1.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.68 / $2.38