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Tennessee 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
$201.18 / $241.74 / $398.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.74 / $241.74 / $265.91
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.18 / $738.05 / $1,006.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $267.95 / $286.93