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North Dakota 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 / $164.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.59 / $164.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.11 / $168.96 / $171.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.75 / $152.26 / $188.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.60 / $164.60 / $493.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.18 / $172.37 / $187.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $172.37 / $177.07