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Tennessee 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 / $42.04 / $66.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.71 / $40.72 / $59.33
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.14 / $100.00 / $169.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $39.56 / $46.68