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Pennsylvania 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
$50.88 / $85.68 / $127.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.18 / $127.20 / $328.07
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.21 / $120.21 / $120.21
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.67 / $123.14 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.98 / $116.98 / $116.98
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.55 / $60.69 / $138.66
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.21 / $120.21 / $120.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.88 / $100.67 / $170.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.18 / $124.00 / $337.93
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.07 / $115.07 / $115.07
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.07 / $115.07 / $115.07
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.93 / $94.93 / $94.93
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.93 / $94.93 / $94.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.74 / $123.14 / $153.93