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Montana rates for HCPCS 90655

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $16.30 / $17.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.51 / $20.51 / $35.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $20.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.51 / $20.51 / $35.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.27 / $16.04 / $23.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.12 / $15.12 / $16.05