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Montana rates for HCPCS 90687

Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $25.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.10 / $16.30 / $19.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.33 / $10.33 / $16.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.10 / $16.30 / $19.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.16 / $12.35 / $18.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.80 / $11.80 / $12.53