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Rhode Island 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
$125.89 / $162.18 / $165.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $199.53