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Michigan 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
$115.81 / $241.74 / $241.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.49 / $242.12 / $418.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.70 / $518.29 / $980.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.27 / $225.27 / $237.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.51 / $265.58 / $265.58
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.11 / $241.74 / $284.39
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.19 / $241.74 / $375.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.57 / $354.57 / $354.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $284.39 / $293.16