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Montana rates for HCPCS 90633

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.10 / $53.10 / $53.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.26 / $45.31 / $75.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.38 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.22 / $45.22 / $78.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.83 / $43.83 / $45.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.22 / $45.22 / $78.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.99 / $41.52 / $53.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $44.70 / $47.47