Pneumococcal conjugate vaccine injection (PCV21)

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

Pcv21 Vaccine for Intramuscular Use

Payers reporting CPT 90684

Payer pricing summary

Low

$180

Average

$1.6k

Median

$486

High

$21.1k

Payer rate distribution

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#
1	Wellmark fee schedule · outpatient · +9 other terms	27	$328	$328	$2	1%	831–885	$328 – $348
2	UnitedHealthcare fee schedule · outpatient · +24 other terms	485	$541	$543	$271	50%	28–46	$37 – $2.0k
3	Aetna fee schedule · outpatient · +23 other terms	123	$339	$731	$741	101%	17	$10 – $8.4k
4	Medica fee schedule · outpatient · +9 other terms	19	$474	$474	—	—	2–20	$474 – $474
5	Cigna fee schedule · outpatient · +18 other terms	237	$496	$914	$587	64%	—	$229 – $2.8k
6	Blue Cross Blue Shield fee schedule · outpatient · +19 other terms	197	$600	$794	$457	58%	—	$1 – $2.1k
7	Humana fee schedule · outpatient · +20 other terms	172	$320	$342	$102	30%	—	$105 – $820
8	Anthem fee schedule · outpatient · +16 other terms	113	$414	$499	$270	54%	—	$166 – $2.2k
9	Caresource fee schedule · outpatient · +11 other terms	55	$328	$288	$186	65%	—	$37 – $557
10	Molina facility · case rate · outpatient · +16 other terms	48	$88	$197	$219	111%	—	$11 – $706
11	Tricare facility · fee schedule · outpatient · +11 other terms	44	$304	$253	$131	52%	—	$0 – $431
12	WellCare facility · fee schedule · outpatient · +14 other terms	37	$324	$252	$103	41%	—	$46 – $344
13	Highmark facility · fee schedule · outpatient · +11 other terms	32	$328	$366	$183	50%	—	$11 – $977
14	Devoted facility · fee schedule · outpatient · +6 other terms	31	$344	$415	$370	89%	—	$45 – $2.2k
15	Bcbs Tx fee schedule · outpatient	30	$1.3k	$1.1k	$381	33%	—	$467 – $2.0k
16	Medcost percent of total billed charges · bothfrom % of charges · +3 other terms	29	$1.9k	$1.8k	$396	22%	—	$753 – $2.8k
17	Kaiser fee schedule · outpatient · +8 other terms	28	$328	$352	$101	29%	—	$301 – $754
18	Amerihealth Caritas facility · fee schedule · outpatient · +9 other terms	27	$16	$60	$111	186%	—	$10 – $328
19	Optum facility · per diem · outpatient · +10 other terms	21	$407	$412	$164	40%	—	$179 – $675
20	Ambetter facility · fee schedule · outpatient · +11 other terms	20	$620	$695	$610	88%	—	$328 – $3.3k
21	Healthpartners fee schedule · outpatient · +3 other terms	18	$391	$391	$9	2%	—	$383 – $400
22	Medicare fee schedule · outpatient · +7 other terms	18	$321	$329	$8	2%	—	$321 – $337
23	Medical Mutual facility · fee schedule · outpatient · +4 other terms	17	$612	$1.1k	$2.5k	230%	—	$344 – $17.6k
24	Oscar facility · fee schedule · outpatient · +10 other terms	13	$407	$356	$84	24%	—	$168 – $407
25	Cigna Healthspring fee schedule · outpatient · +3 other terms	12	$344	$344	—	—	—	$344 – $344

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