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Utah rates for HCPCS 90671

Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $309.03 / $446.68
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $281.84 / $660.69
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $263.03 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $281.84 / $288.40