go back

South Dakota rates for HCPCS 90687

Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.34 / $9.34 / $9.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.34 / $10.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.65 / $10.65 / $13.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.99 / $15.37 / $25.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.99 / $11.48 / $11.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.28 / $12.84 / $14.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.28 / $12.74 / $16.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.44 / $10.44 / $26.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.99 / $11.48 / $11.80
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.22 / $9.22 / $9.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.22 / $9.22 / $9.22