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Montana 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
$172.80 / $224.10 / $231.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.00 / $241.74 / $364.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.58 / $265.58 / $265.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.58 / $265.58 / $268.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.95 / $267.95 / $284.56