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Montana rates for HCPCS 90647

Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.00 / $55.80 / $104.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.42 / $32.35 / $53.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.66 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.38 / $38.38 / $66.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.25 / $35.25 / $38.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.38 / $38.38 / $66.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.78 / $35.04 / $45.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.56 / $35.56 / $37.76