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South Dakota rates for HCPCS 90634

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.75 / $30.75 / $30.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $30.75 / $34.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.75 / $19.69 / $30.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.97 / $51.97 / $84.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.28 / $26.71 / $29.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.85 / $52.19 / $54.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.67 / $52.19 / $67.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.85 / $10.85 / $10.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.28 / $26.71 / $27.44