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New Hampshire rates for HCPCS 90658

Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $24.55 / $33.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $41.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $18.62 / $29.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $57.54 / $95.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $22.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $37.15 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $19.95 / $23.99