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South Dakota rates for HCPCS 90671

Pcv15 Vaccine For Intramuscular Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.78 / $261.14 / $261.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.00 / $261.14 / $347.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.06 / $268.72 / $332.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.89 / $441.34 / $715.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.12 / $252.12 / $261.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.38 / $313.38 / $349.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.06 / $313.38 / $380.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.31 / $245.31 / $245.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.56 / $264.68 / $271.89
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.14 / $261.14 / $261.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.14 / $261.14 / $261.14