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Washington rates for HCPCS B4159

Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.41 / $1.47
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $4.92 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.14 / $1.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.80 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $3.48 / $4.92