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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
$15.85 / $16.22 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $22.39 / $25.70
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $22.39 / $25.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $35.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $30.20 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $16.22