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California rates for HCPCS M0201

Administration Of Pneumococcal Influenza Hepatis B And/Or Covid-19 Vaccine Inside A Patients Home; Reported Only Once Per Individual Home Per Date Of Service When Such Vaccine Administration(S) Are Performed At The Patients Home (Desc Rvsd 1/1/2024)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.65 / $39.65 / $39.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.80 / $113.80 / $113.80
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.75 / $93.02 / $117.63
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.50 / $35.50 / $96.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.89 / $31.89 / $31.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.53 / $49.21 / $96.29
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.34 / $211.40 / $211.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.77 / $51.80 / $70.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.89 / $41.70 / $43.77
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.40 / $46.15 / $63.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.65 / $41.97 / $115.45