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South Dakota rates for HCPCS 90648

Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $21.38 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $15.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $23.99 / $48.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $14.45 / $21.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $15.14 / $16.60
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18