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South Dakota rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $6.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $4.90 / $10.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.18 / $7.18 / $7.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $2.90 / $2.90