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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

Professionalmedian $162 · 10th–90th $135–$2090%20%40%10th90th$162$20.0$50.0$100.0$200.0$500.0

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $199.53 / $251.19
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $165.96