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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
$287.67 / $287.67 / $617.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.42 / $247.50 / $418.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.58 / $265.58 / $265.58
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
$241.74 / $256.24 / $345.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $237.13 / $260.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.69 / $151.69 / $186.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.83 / $312.83 / $319.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.95 / $284.56 / $284.56