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South Dakota rates for HCPCS 86684

Antibody Haemophilus Influenza

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.89 / $14.89 / $14.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.61 / $14.28 / $126.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.33 / $31.33 / $31.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.17 / $28.72 / $35.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $25.40 / $114.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.50 / $14.26 / $29.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.44 / $32.27 / $49.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.44 / $35.00 / $45.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $36.99 / $43.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.65 / $10.08 / $19.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.84 / $15.84 / $15.84