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Idaho 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
$288.40 / $288.40 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $263.03 / $426.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $194.98 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $281.84 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $251.19 / $309.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $251.19 / $407.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $281.84 / $302.00