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Alaska rates for HCPCS 90671

Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.00 / $512.00 / $512.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.45 / $261.14 / $287.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.49 / $269.49 / $269.49
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.28 / $241.28 / $241.28
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.14 / $261.14 / $840.90
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.85 / $384.85 / $604.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.73 / $168.73 / $168.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.28 / $373.67 / $880.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.13 / $269.49 / $283.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.62 / $240.62 / $288.60