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Montana rates for HCPCS 90634

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $30.75 / $58.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.32 / $47.32 / $47.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.32 / $47.32 / $47.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.32 / $47.32 / $47.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.20 / $39.31 / $65.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.44 / $27.44 / $29.14