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Montana rates for HCPCS 90658

Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $21.88 / $41.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $25.12
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $26.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $26.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $35.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $30.90 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $23.99