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Washington rates for HCPCS B4162

Enternal Formula For Pediatrics Special Metabolic Needs For Inherited Disease

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 / $4.18
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $11.27 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $2.47 / $4.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
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
$1.20 / $2.29 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $8.19 / $11.39