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South Dakota rates for HCPCS B4197

Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 g of protein - premix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.17 / $386.17 / $386.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.17 / $386.17 / $396.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.25 / $474.95 / $587.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.70 / $566.58 / $1,085.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $387.91 / $678.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.99 / $452.56 / $521.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.84 / $506.53 / $852.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.21 / $405.72 / $537.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $202.41 / $678.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.72 / $405.72 / $405.72