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Alaska rates for HCPCS 90697

Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use

Facilitymedian $166 · 10th–90th $129–$3800%20%10th90th$166Professionalmedian $162 · 10th–90th $105–$1820%50%10th90th$162$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $162.18 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $165.96
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $165.96 / $186.21
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $407.38
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $147.91
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $186.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $169.82 / $199.53