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South Dakota rates for HCPCS 90733

Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $154.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $213.80 / $346.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $162.18 / $162.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $162.18 / $165.96