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Montana rates for HCPCS 90672

Laiv4 Vaccine For Intranasal Use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.85 / $27.34 / $44.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.84 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.31 / $43.64 / $55.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.44 / $27.44 / $43.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.31 / $43.64 / $55.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.34 / $35.75 / $49.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.40 / $31.40 / $33.35