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South Dakota rates for HCPCS B4189

Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 g of protein, premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.48 / $245.48 / $245.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.48 / $245.48 / $251.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.88 / $301.86 / $373.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.38 / $360.16 / $690.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.78 / $246.59 / $431.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.87 / $287.69 / $331.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.84 / $322.54 / $542.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.86 / $257.89 / $341.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.78 / $192.82 / $431.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.89 / $257.89 / $257.89