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Michigan rates for HCPCS 90476

Adenovirus vaccine, type 4, live, for oral use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.00 / $106.00 / $106.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.00 / $29.00 / $29.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $103.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00