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Washington 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
$62.66 / $104.67 / $104.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $125.12 / $328.07
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.30 / $128.47 / $305.89
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.83 / $110.83 / $124.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.68 / $115.07 / $371.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.07 / $115.07 / $115.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $6.67 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.09 / $127.50 / $129.31
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.75 / $207.00 / $373.75
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.93 / $112.51 / $124.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.30 / $96.36 / $183.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.83 / $110.83 / $110.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.74 / $116.10 / $123.29