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New Hampshire 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 / $100.67 / $112.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.67 / $104.67 / $104.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.83 / $154.11 / $422.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.80 / $100.80 / $104.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.07 / $115.07 / $115.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.07 / $115.07 / $115.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.06 / $174.28 / $323.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.74 / $102.74 / $123.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.18 / $107.67 / $162.61