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New Hampshire 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 / $62.67 / $62.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.71 / $40.72 / $40.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.78 / $58.70 / $161.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.63 / $39.63 / $39.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.99 / $66.23 / $122.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $39.56 / $45.49
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.63 / $40.72 / $62.48