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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
$40.74 / $45.71 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $123.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $37.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $81.28 / $144.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $40.74 / $46.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $67.61 / $77.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $39.81 / $45.71