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Washington 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
$0.71 / $0.73 / $6.48
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.69 / $17.07 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $2.49 / $5.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $8.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $3.68 / $8.37
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.69 / $12.18 / $19.32