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Wisconsin rates for HCPCS 90476

Adenovirus vaccine, type 4, live, for oral use

Facilitymedian $49 · 10th–90th $44–$3800%50%10th90th$49Professionalmedian $170 · 10th–90th $65–$2040%50%10th90th$170$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $204.17
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $48.98 / $380.19
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $20.42