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South Dakota rates for HCPCS B4105

In-line cartridge containing digestive enzyme(s) for enteral feeding, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.34 / $154.34 / $154.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.00 / $183.00 / $228.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.71 / $260.83 / $422.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.31 / $133.31 / $133.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.38 / $140.38 / $140.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.83 / $130.83 / $130.83