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South Dakota rates for HCPCS 90750

Hzv Zoster Vacc Recombinant Adjuvanted Im Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.08 / $330.29 / $404.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.44 / $219.81 / $246.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.00 / $199.98 / $247.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.61 / $315.77 / $602.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.06 / $237.06 / $237.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.73 / $214.73 / $214.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.73 / $214.73 / $220.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.82 / $219.82 / $219.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.06 / $237.06 / $243.53
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.51 / $215.51 / $215.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.51 / $215.51 / $215.51