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Montana rates for HCPCS 90713

Poliovirus Vaccine Inactivated Subq/Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.00 / $59.00 / $271.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.33 / $47.64 / $75.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.12 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.38 / $38.38 / $66.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.38 / $50.10 / $50.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.38 / $38.38 / $66.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.78 / $35.04 / $51.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.54 / $50.54 / $53.68