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Pennsylvania rates for HCPCS 90677

Pcv20 Vaccine For Intramuscular Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.34 / $228.14 / $570.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.60 / $368.84 / $619.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.00 / $490.00 / $610.00
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.60 / $394.24 / $2,639.42
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.08 / $273.08 / $321.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.95 / $329.37 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.89 / $312.89 / $312.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.55 / $307.55 / $307.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.55 / $307.55 / $307.55
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $263.60 / $1,419.00
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.60 / $491.34 / $2,030.33
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.08 / $312.89 / $321.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.00 / $340.59 / $1,599.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.72 / $360.83 / $595.14
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.69 / $564.13 / $879.91
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.55 / $307.55 / $307.55
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.55 / $307.55 / $307.55
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.72 / $283.72 / $329.22
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.72 / $283.72 / $329.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.60 / $334.54 / $418.18