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South Dakota rates for HCPCS 90672

Laiv4 Vaccine For Intranasal Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.86 / $24.86 / $24.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.85 / $24.86 / $31.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.31 / $28.31 / $35.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.25 / $42.01 / $68.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.25 / $30.57 / $30.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.25 / $34.18 / $38.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.00 / $33.92 / $42.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $27.79 / $27.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.93 / $30.57 / $31.40
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.50 / $24.50 / $24.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.50 / $24.50 / $24.50