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Kansas 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
Facility
Modifier
Low / Median / High Price
$187.04 / $197.52 / $205.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.60 / $205.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.64 / $198.54 / $208.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.04 / $187.04 / $187.04
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.60 / $175.01 / $245.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.36 / $184.91 / $188.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $184.91 / $188.04