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South Dakota rates for HCPCS B4164

Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit), home mix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.47 / $23.47 / $23.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.47 / $23.47 / $24.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.50 / $28.79 / $35.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.07 / $34.43 / $65.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $23.57 / $41.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.05 / $27.50 / $31.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.01 / $31.03 / $51.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.08 / $24.66 / $32.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $12.30 / $41.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.66 / $24.66 / $24.66