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South Dakota rates for HCPCS 90655

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $16.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $27.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $15.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $27.54 / $44.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $14.79 / $14.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $14.79 / $16.98