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Massachusetts rates for HCPCS B4158

Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $1.26 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.55 / $0.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.70 / $3.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $3,630.78 / $9,772.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $1.26 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.55 / $0.55