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Utah 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
$32.36 / $32.36 / $32.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $32.36 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $35.48
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $33.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $32.36 / $32.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $37.15 / $38.02