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Tennessee 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
$99.51 / $101.65 / $166.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.67 / $104.67 / $138.27
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.51 / $236.86 / $431.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.74 / $102.74 / $123.14