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South Dakota rates for HCPCS 90621

Menb-Fhbp Recombnt Lipoprotein Vacc 2/3 Dose Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.34 / $211.34 / $211.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.34 / $211.34 / $353.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.13 / $192.03 / $237.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.49 / $302.22 / $579.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.05 / $228.05 / $228.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.83 / $215.83 / $215.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.34 / $211.34 / $211.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.05 / $228.05 / $234.27
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.32 / $207.32 / $207.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.32 / $207.32 / $207.32