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Utah rates for HCPCS 90677

Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $323.59 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $302.00 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $354.81 / $524.81
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $323.59 / $707.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $316.23 / $389.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $354.81 / $354.81