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South Dakota rates for HCPCS B4155

Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $2 · 10th–90th $1–$20%20%40%10th$2Professionalmedian $1 · 10th–90th $1–$20%20%10th90th$1$0.5$1.0$2.0$5.0$10.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.82 / $1.82 / $1.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $10.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.12 / $1.55 / $2.95
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.32 / $0.95 / $1.66
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.23 / $1.23 / $1.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.87 / $1.02 / $2.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.32 / $0.95 / $1.58