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Wisconsin rates for HCPCS 90739

Hepatitis B vaccine (HepB), CpG-adjuvanted, adult dosage, 2 dose or 4 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.56 / $355.12 / $750.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.60 / $184.73 / $343.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.47 / $381.73 / $395.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.87 / $158.87 / $216.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.10 / $371.10 / $371.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.44 / $408.60 / $584.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.90 / $352.47 / $400.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.56 / $177.56 / $391.34
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.12 / $355.12 / $355.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.65 / $177.56 / $391.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.75 / $186.90 / $355.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $85.00 / $433.25
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.56 / $177.56 / $391.34
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.12 / $355.12 / $355.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.56 / $396.60 / $590.51
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$664.35 / $664.35 / $664.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.44 / $174.44 / $174.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.88 / $249.29 / $249.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.75 / $176.00 / $255.43