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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

Facilitymedian $2 · 10th–90th $2–$60%50%90th$2Professionalmedian $1 · 10th–90th $0–$10%50%10th$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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.37 / $1.05 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.46 / $0.46
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.14 / $2.14 / $4.27
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.87 / $0.87 / $1.26
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $8,511.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.37 / $1.05 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.46 / $0.46