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Pennsylvania 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
$32.76 / $40.72 / $68.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.26 / $52.00 / $132.88
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.13 / $46.13 / $46.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.60 / $44.23 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.02 / $42.02 / $42.02
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.97 / $54.62 / $158.46
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.13 / $46.13 / $46.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.19 / $40.58 / $146.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.20 / $52.00 / $132.88
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.13 / $107.60 / $155.13
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.17 / $38.17 / $38.17
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.17 / $38.17 / $38.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $42.66 / $51.19