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Washington 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 $135–$1860%20%40%10th90th$162Professionalmedian $182 · 10th–90th $151–$3550%20%10th90th$182$20.0$50.0$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 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $181.97 / $354.81
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $354.81 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $151.36 / $407.38
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $186.21 / $186.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $190.55 / $199.53
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88