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New Hampshire 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

Facilitymedian $229 · 10th–90th $166–$6170%10%20%10th90th$229Professionalmedian $166 · 10th–90th $162–$2950%50%10th90th$166$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $165.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $346.74 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $169.82 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $398.11 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $281.84 / $323.59
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $169.82 / $257.04