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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.45 / $368.24 / $415.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $177.75 / $354.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.93 / $366.49 / $1,018.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.75 / $159.75 / $276.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.97 / $179.24 / $59,702.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.97 / $158.97 / $158.97
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 / $265.82
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.88 / $210.61 / $380.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.41 / $175.41 / $265.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.87 / $177.07 / $212.46