go back

Ohio rates for HCPCS 90734

Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.90 / $222.78 / $412.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.52 / $169.96 / $292.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.96 / $159.96 / $159.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.13 / $390.20 / $1,083.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.09 / $170.09 / $286.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.32 / $231.32 / $323.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.32 / $231.32 / $312.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.76 / $186.76 / $186.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.76 / $186.76 / $277.27
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.48 / $78.48 / $485.57
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.73 / $186.76 / $277.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.23 / $207.42 / $245.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.41 / $191.76 / $218.44