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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

Facilitymedian $2 · 10th–90th $2$50%50%90th$2Professionalmedian $1 · 10th–90th $1$20%50%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
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$2.00
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$0.44
Median
$1.26
Typical High
$100.00
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$0.44
Median
$0.55
Typical High
$0.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$1.70
Typical High
$3.39
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.52
Typical High
$0.74
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$8,511.38
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$0.44
Median
$1.26
Typical High
$100.00
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$0.44
Median
$0.55
Typical High
$0.55