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Tennessee rates for HCPCS 90647

Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.42 / $32.35 / $51.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.35 / $32.35 / $43.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.25 / $35.25 / $35.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.25 / $35.25 / $35.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.51 / $100.00 / $133.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.47 / $35.56 / $37.61