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South Dakota rates for HCPCS B4160

Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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
$0.34 / $0.34 / $0.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $1.07 / $1.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.95 / $0.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $0.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00