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Washington rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.13 / $2.68
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.20 / $8.25 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $2.64 / $3.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.54 / $5.77
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.29 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.20 / $5.64 / $8.25