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South Dakota rates for HCPCS B4222

Parenteral nutrition supply kit; home mix, per day

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.64 / $13.64 / $13.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $13.64 / $13.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.50 / $16.67 / $20.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $20.01 / $38.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $13.69 / $23.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.71 / $15.97 / $18.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.21 / $17.73 / $30.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $14.33 / $18.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $10.71 / $23.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.90 / $12.90 / $12.90