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Hawaii rates for HCPCS 90677

Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.93 / $364.93 / $386.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.74 / $312.89 / $549.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.55 / $307.55 / $307.55
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.43 / $296.43 / $296.43
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.19 / $375.48 / $438.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.54 / $357.64 / $411.90
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.45 / $274.64 / $288.33