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South Dakota rates for HCPCS 90620

Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.74 / $241.74 / $284.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $241.74 / $304.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.88 / $226.11 / $279.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.74 / $345.69 / $662.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.83 / $260.83 / $260.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.80 / $250.80 / $250.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.80 / $250.80 / $253.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.74 / $241.74 / $241.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.83 / $260.83 / $284.39
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.13 / $237.13 / $237.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $237.13 / $237.13