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Louisiana 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
$241.74 / $241.74 / $435.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.00 / $241.74 / $327.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.18 / $270.18 / $405.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.18 / $270.18 / $275.58
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.75 / $192.75 / $192.75
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.42 / $267.95 / $284.56