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Montana 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
$117.90 / $117.90 / $117.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.75 / $115.23 / $171.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.64 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.48 / $101.48 / $176.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.48 / $115.07 / $115.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.48 / $101.48 / $176.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.64 / $93.28 / $120.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.10 / $116.10 / $123.29