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South Dakota rates for HCPCS 90396

Varicella-Zoster Immune Globulin Human Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,182.50 / $2,204.33 / $2,728.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,171.61 / $3,326.71 / $6,374.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.63 / $2,584.10 / $2,584.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.04 / $182.99 / $3,941.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $199.58 / $252.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $2,326.37 / $2,326.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,248.05 / $2,584.10 / $2,654.57
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,280.76 / $2,280.76 / $2,280.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,280.76 / $2,280.76 / $2,280.76