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Pennsylvania 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
$13.32 / $22.07 / $57.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.97 / $22.07 / $31.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.75 / $23.23 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.07 / $22.07 / $22.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.82 / $21.82 / $21.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.82 / $21.82 / $21.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.07 / $22.07 / $57.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.22 / $22.40 / $32.86
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.82 / $21.82 / $21.82
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.82 / $21.82 / $21.82
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.13 / $15.13 / $18.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.72 / $23.98 / $36.09