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Hawaii 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.00 / $168.75 / $352.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.41 / $175.41 / $175.41
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.44 / $168.44 / $168.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.66 / $187.09 / $235.05
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.01 / $147.07 / $164.54