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South Dakota rates for HCPCS B4176

Parenteral Nutrition Solution; Amino Acid 7% Through 8.5% (500 Ml = 1 Unit) - Homemix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.22 / $66.22 / $66.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.22 / $66.22 / $67.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.63 / $81.43 / $100.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.09 / $97.15 / $186.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.14 / $66.50 / $116.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.30 / $77.59 / $89.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.28 / $86.45 / $146.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.94 / $69.56 / $92.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.14 / $27.18 / $116.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $69.56 / $69.56