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Massachusetts rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $1.32 / $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
$1.75 / $2.06 / $4.57
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
$60.00 / $3,504.00 / $9,239.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $100.00