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Wisconsin rates for HCPCS 90655

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $16.22 / $16.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $27.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $27.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $30.90 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $24.55 / $28.18
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $14.79 / $21.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $14.79 / $21.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $19.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $54.95 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $31.62 / $43.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $100.00 / $100.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $22.91 / $51.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.88 / $12.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $21.88