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Maine 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
$164.59 / $164.59 / $164.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.25 / $484.25 / $484.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.75 / $159.75 / $159.75
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.97 / $183.94 / $282.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.59 / $181.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $156.69 / $235.05