go back

South Dakota rates for HCPCS B4187

Omegaven, 10 Grams Lipids

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.51 / $15.51 / $15.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.51 / $15.51 / $15.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.75 / $18.94 / $23.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.55 / $22.75 / $43.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $16.26 / $28.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.88 / $18.57 / $20.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.88 / $20.49 / $35.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.91 / $18.32 / $21.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $14.16 / $28.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.29 / $16.29 / $16.29