Hepatitis A vaccine, children and teens, two-dose series

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Hepa Vaccine 2 Dose Schedule Ped/Adolesc Im Use

Payers reporting CPT 90633

Payer pricing summary

Low

Average

$92

Median

$60

High

$373

Payer rate distribution

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#
1	Wellmark fee schedule · outpatient · +17 other terms	27	$39	$40	$6	15%	260	$38 – $75
2	Anthem fee schedule · outpatient · +23 other terms	99	$47	$59	$47	80%	4–40	$2 – $313
3	UnitedHealthcare fee schedule · outpatient · +29 other terms	486	$70	$71	$37	53%	2–20	$0 – $596
4	Blue Cross Blue Shield fee schedule · outpatient · +31 other terms	281	$75	$97	$64	66%	2–20	$0 – $356
5	Cigna fee schedule · outpatient · +24 other terms	262	$72	$121	$75	62%	—	$0 – $372
6	Humana fee schedule · outpatient · +23 other terms	186	$40	$167	$682	409%	—	$9 – $8.3k
7	Aetna fee schedule · outpatient · +30 other terms	131	$45	$175	$708	405%	—	$0 – $8.4k
8	Medica fee schedule · outpatient · +17 other terms	51	$76	$94	$68	73%	—	$20 – $319
9	MultiPlan fee schedule · outpatient · +18 other terms	50	$112	$111	$75	67%	—	$4 – $406
10	Molina facility · case rate · outpatient · +25 other terms	37	$20	$15	$7	46%	—	$6 – $36
11	Amerihealth Caritas facility · fee schedule · outpatient · +13 other terms	35	$12	$16	$12	71%	—	$10 – $55
12	Highmark facility · fee schedule · outpatient · +19 other terms	31	$12	$63	$73	116%	—	$11 – $237
13	Caresource fee schedule · outpatient · +17 other terms	29	$41	$39	$2	5%	—	$37 – $41
14	Bcbs Tx fee schedule · outpatient · +2 other terms	24	$169	$163	$45	28%	—	$27 – $260
15	Regence facility · fee schedule · both · +15 other terms	22	$39	$44	$20	45%	—	$18 – $127
16	Tricare fee schedule · both · +16 other terms	22	$40	$40	$1	4%	—	$39 – $47
17	Premera facility · fee schedule · both · +10 other terms	21	$39	$45	$20	44%	—	$21 – $127
18	Carefirst facility · fee schedule · both · +11 other terms	20	$39	$46	$20	43%	—	$39 – $127
19	Excellus facility · fee schedule · both · +13 other terms	20	$39	$45	$18	41%	—	$39 – $127
20	Kaiser fee schedule · outpatient · +19 other terms	19	$84	$82	$58	71%	—	$3 – $261
21	First Health fee schedule · outpatient · +19 other terms	18	$122	$123	$78	63%	—	$0 – $348
22	Medicaid fee schedule · both · +15 other terms	17	$43	$42	$25	60%	—	$16 – $70
23	Aetna Better Health fee schedule · outpatient · +13 other terms	14	$37	$38	$3	9%	—	$33 – $40
24	Bcbs La fee schedule · outpatient · +2 other terms	14	$43	$43	$1	3%	—	$40 – $44
25	WellCare fee schedule · both · +19 other terms	14	$16	$12	$19	165%	—	$0 – $87

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