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Utah 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
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $151.36
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $107.15 / $109.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $165.96 / $177.83