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Utah rates for HCPCS 90681

Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $147.91 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $151.36 / $151.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $173.78 / $177.83