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South Dakota rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $1.48 / $2.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.86 / $1.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.35 / $1.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.58 / $2.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $0.86 / $1.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.79 / $1.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.23