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Utah 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
$86.14 / $104.67 / $109.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.18 / $104.67 / $163.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.07 / $115.07 / $115.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.87 / $91.86 / $116.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.74 / $121.23 / $123.29