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South Dakota rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, 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
$0.44 / $0.44 / $0.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $0.68 / $0.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.41 / $0.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.63 / $0.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.73 / $1.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.43 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.41 / $0.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56