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South Dakota rates for HCPCS 90681

Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.83 / $149.83 / $149.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.38 / $149.83 / $178.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.75 / $140.13 / $173.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.27 / $214.26 / $410.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.43 / $161.72 / $161.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.08 / $111.02 / $134.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.33 / $122.62 / $157.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.83 / $149.83 / $149.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.90 / $161.72 / $166.13
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.02 / $147.02 / $147.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.02 / $147.02 / $147.02