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South Dakota rates for HCPCS B4193

Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 g of protein, premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $316.23 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $275.42 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $478.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $467.74 / $891.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $331.13 / $562.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $331.13 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $316.23 / $537.03