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Massachusetts rates for HCPCS B4155

Enteral Formula Nutritionally Incomplete/Modular Nutients Includes Specific Calories = 1 Unit (Special Coverage Instructions A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.60
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $0.96 / $90.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.91 / $1.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $2.08 / $4.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $3,504.00 / $9,239.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.75 / $1.75 / $90.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.91 / $1.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.95 / $3.10