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South Dakota rates for HCPCS 90696

Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $139.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.13 / $61.74 / $76.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.79 / $95.18 / $182.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.06 / $70.06 / $70.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.22 / $71.22 / $71.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.22 / $71.22 / $71.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.57 / $63.57 / $63.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.06 / $70.06 / $71.98
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.82 / $62.82 / $62.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.82 / $62.82 / $62.82