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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
$16.30 / $16.30 / $16.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $16.30 / $20.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.75 / $13.99 / $15.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.31 / $27.55 / $44.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $14.72 / $14.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.92 / $25.10 / $28.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.96 / $25.10 / $28.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $26.00 / $26.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.38 / $14.72 / $15.12