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Massachusetts rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $4.07 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.78 / $1.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.09 / $3.09 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
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
$1.45 / $4.07 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.78 / $1.78