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Washington rates for HCPCS 90671

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $288.40 / $707.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $263.03 / $416.87
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $512.86 / $741.31
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $275.42 / $275.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $380.19 / $724.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $257.04 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $269.15 / $288.40
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $346.74