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Wisconsin rates for HCPCS 90677

Pcv20 Vaccine For Intramuscular Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.15 / $408.10 / $594.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.00 / $325.54 / $552.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.87 / $672.74 / $697.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.08 / $280.08 / $381.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.64 / $653.96 / $653.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.55 / $723.56 / $1,034.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.83 / $634.79 / $721.36
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.89 / $312.89 / $689.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.79 / $625.79 / $625.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.08 / $399.83 / $600.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.60 / $312.89 / $625.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $85.00 / $763.48
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.89 / $312.89 / $689.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.79 / $625.79 / $625.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.89 / $702.45 / $1,013.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.64 / $1,176.64 / $1,176.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.55 / $307.55 / $307.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.89 / $439.31 / $447.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.60 / $310.30 / $439.36