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Indiana rates for HCPCS 90633

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.42 / $91.22 / $170.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.97 / $40.72 / $69.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.09 / $78.26 / $117.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.68 / $39.63 / $56.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.65 / $25.65 / $33.35
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.65 / $25.65 / $28.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.03 / $43.83 / $117.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $42.66 / $67.25