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Montana rates for HCPCS 90648

Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.80 / $78.80 / $78.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.32 / $16.30 / $62.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.83 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.75 / $35.75 / $62.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.75 / $14.75 / $35.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.75 / $35.75 / $62.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.75 / $28.41 / $42.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.83 / $13.83 / $13.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.02 / $15.02 / $15.95