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New Hampshire rates for HCPCS 90734

Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.16 / $169.96 / $190.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.35 / $250.13 / $686.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.09 / $170.09 / $170.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.76 / $186.76 / $186.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.76 / $186.76 / $186.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.32 / $276.02 / $524.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.75 / $166.75 / $199.95
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.41 / $168.67 / $254.74