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South Dakota rates for HCPCS 90713

Poliovirus Vaccine Inactivated Subq/Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.64 / $47.64 / $47.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $47.64 / $53.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.75 / $43.18 / $53.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.91 / $68.13 / $130.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $49.20 / $49.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.14 / $41.88 / $52.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.19 / $46.83 / $54.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.88 / $45.50 / $45.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.20 / $49.20 / $50.54
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.73 / $44.73 / $44.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.73 / $44.73 / $44.73