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Pennsylvania rates for HCPCS 90733

Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $144.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $181.97
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $138.04 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $114.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $125.89 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $213.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $123.03 / $323.59
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $123.03 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $186.21