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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
$317.18 / $317.18 / $317.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.18 / $317.18 / $325.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.25 / $390.11 / $482.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.88 / $465.36 / $891.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.83 / $318.62 / $557.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.49 / $371.73 / $428.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.06 / $416.75 / $700.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.43 / $333.24 / $441.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.83 / $249.17 / $557.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.24 / $333.24 / $333.24