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Kentucky 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
$164.60 / $164.60 / $309.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.60 / $207.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.85 / $188.39 / $188.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.78 / $159.75 / $159.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.24 / $197.16 / $322.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.77 / $179.24 / $233.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.97 / $175.41 / $175.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.41 / $228.75 / $228.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $180.21 / $187.09