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Washington 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
$60.43 / $298.37 / $489.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.10 / $265.91 / $728.66
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.96 / $268.35 / $1,006.31
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.93 / $255.96 / $284.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.58 / $265.58 / $742.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.58 / $265.58 / $265.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $170.75 / $426.87
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.04 / $187.04 / $187.04
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.35 / $268.35 / $268.35
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.36 / $254.93 / $281.77
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.96 / $255.96 / $255.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.96 / $255.96 / $255.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $267.95 / $284.56