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Virginia 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 $162 · 10th–90th $162–$3310%50%90th$162Professionalmedian $166 · 10th–90th $141–$2140%50%10th90th$166$100.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $162.18 / $213.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $371.54 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $251.19
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $190.55 / $281.84
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $190.55 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $616.60 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $199.53 / $208.93