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Montana rates for HCPCS 90733

Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $138.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $147.91 / $169.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $147.91 / $169.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $234.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $85.11 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $177.83