go back

South Dakota rates for HCPCS 90633

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $40.74 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $45.71 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $47.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $57.54 / $109.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $42.66 / $42.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $43.65 / $44.67
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90