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Massachusetts rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based 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
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
$0.46 / $1.10 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.46 / $0.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $2.16 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
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