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South Dakota rates for HCPCS 90657

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $11.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $18.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $14.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $15.85 / $30.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $10.96 / $11.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $10.96 / $11.75
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96