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Idaho 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
$154.01 / $164.60 / $313.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.41 / $175.41 / $175.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.41 / $175.41 / $175.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.60 / $174.48 / $235.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.62 / $156.62 / $172.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.86 / $205.86 / $210.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.07 / $188.04 / $188.04