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Ohio 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 $363 · 10th–90th $178$4790%20%10th90th$363Professionalmedian $182 · 10th–90th $162$3160%20%40%10th90th$182$2.0$10.0$50.0$200.0$1.0K

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
$169.82 / $371.54 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $181.97 / $389.05
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $158.49 / $169.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $363.08 / $1,096.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $194.98 / $323.59
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $467.74 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $208.93 / $478.63
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $263.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $50.12
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $199.53 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $190.55 / $199.53