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Alaska rates for HCPCS 90620

Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.12 / $415.26 / $996.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.50 / $241.74 / $265.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.58 / $265.58 / $265.58
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.54 / $214.54 / $214.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $237.13 / $237.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.69 / $375.69 / $590.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.35 / $128.35 / $128.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.54 / $375.69 / $885.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.07 / $127.07 / $265.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $237.13 / $284.39