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Nebraska rates for HCPCS 90671

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.14 / $261.14 / $378.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.78 / $261.14 / $320.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.29 / $295.64 / $480.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.86 / $292.68 / $295.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.06 / $269.49 / $332.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.56 / $567.97 / $1,000.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.20 / $252.12 / $275.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.43 / $313.38 / $349.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.93 / $313.38 / $380.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.62 / $264.68 / $288.60