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Montana rates for HCPCS 90677

Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.57 / $391.55 / $604.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.72 / $325.00 / $568.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.18 / $357.18 / $357.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.55 / $307.55 / $357.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.18 / $357.18 / $357.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.55 / $339.47 / $442.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.30 / $310.30 / $329.52