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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

Facilitymedian $1 · 10th–90th $1–$1860%50%90th$1Professionalmedian $162 · 10th–90th $158–$1660%50%10th90th$162$1.0$5.0$20.0$100.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $165.96
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.50 / $0.50 / $0.50
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $169.82 / $199.53