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South Dakota rates for HCPCS B4199

Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 100 Grams Of Protein - Premix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.26 / $441.26 / $441.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.26 / $441.26 / $452.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.38 / $542.75 / $671.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.88 / $647.40 / $1,240.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $443.26 / $775.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.47 / $517.13 / $595.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.18 / $579.67 / $974.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.73 / $463.60 / $613.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $346.65 / $775.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.60 / $463.60 / $463.60