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Tennessee 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
$164.60 / $164.60 / $381.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.60 / $181.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.62 / $175.62 / $175.62
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 / $175.41
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.69 / $374.08 / $675.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $177.07 / $187.09