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Utah rates for HCPCS 90657

Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $10.96 / $13.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $15.49 / $23.99
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $11.48 / $11.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $10.96 / $13.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $11.75 / $12.02