go back

South Dakota rates for HCPCS 90694

Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.05 / $69.22 / $80.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $69.22 / $82.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.83 / $78.83 / $98.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.43 / $116.98 / $189.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.43 / $85.10 / $85.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.29 / $95.15 / $95.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.08 / $94.41 / $159.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $77.36 / $77.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.43 / $85.10 / $87.42
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.98 / $67.98 / $67.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.98 / $67.98 / $67.98