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Maryland 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
$237.05 / $284.79 / $750.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.50 / $232.50 / $249.75
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.74 / $241.74 / $241.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.58 / $265.58 / $265.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.96 / $255.96 / $255.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.40 / $267.95 / $284.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.80 / $237.80 / $237.80