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South Dakota rates for HCPCS 90647

Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.35 / $32.35 / $32.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.42 / $32.35 / $43.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.63 / $35.25 / $37.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.54 / $45.44 / $86.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $33.64 / $33.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.14 / $41.88 / $46.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.19 / $41.95 / $54.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.00 / $31.98 / $31.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.61 / $34.61 / $35.56
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.58 / $30.58 / $30.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.58 / $30.58 / $30.58