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South Dakota rates for HCPCS B4220

Parenteral nutrition supply kit; premix, per day

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.05 / $11.05 / $11.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.05 / $11.05 / $11.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $13.64 / $16.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.87 / $16.22 / $31.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $11.10 / $19.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.74 / $12.95 / $14.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.90 / $14.42 / $24.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.34 / $11.61 / $15.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $5.80 / $19.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.45 / $10.45 / $10.45