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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
$40.72 / $40.72 / $40.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.64 / $40.72 / $56.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.88 / $42.45 / $47.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.65 / $57.80 / $110.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.82 / $42.89 / $42.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.50 / $48.24 / $52.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.79 / $49.20 / $64.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.78 / $39.78 / $47.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $43.52 / $44.70
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.85 / $38.85 / $38.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.85 / $38.85 / $38.85