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Massachusetts rates for HCPCS B4155

Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $2 · 10th–90th $2–$240%50%10th90th$2Professionalmedian $1 · 10th–90th $1–$20%20%10th90th$1$0.5$5.0$50.0$500.0$5.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $2.45
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.14 / $2.45 / $3.39
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.91 / $0.95 / $89.13
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.50 / $0.91 / $1.58
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.70 / $1.70 / $3.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $5.89 / $5.89
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.50 / $0.93 / $1.58
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.91 / $0.95 / $89.13
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.50 / $0.91 / $1.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.68 / $0.68 / $0.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.39 / $0.93 / $1.58