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Michigan rates for HCPCS 90680

Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.67 / $104.67 / $153.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.75 / $115.13 / $172.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.65 / $224.56 / $424.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.60 / $97.60 / $102.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.08 / $115.07 / $115.07
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.67 / $109.90 / $153.02
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.75 / $108.90 / $166.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.74 / $123.14 / $127.02