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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
$125.50 / $125.50 / $138.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.30 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.13 / $135.13 / $235.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.13 / $137.94 / $137.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.13 / $135.13 / $235.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.97 / $124.56 / $159.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $166.84 / $177.18