go back

Wisconsin 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 $182 · 10th–90th $85–$3800%20%10th90th$182Professionalmedian $170 · 10th–90th $162–$3550%50%10th90th$170$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
$85.11 / $165.96 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $173.78 / $380.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $363.08 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $190.55 / $323.59
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $186.21 / $186.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $186.21 / $186.21
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $177.83 / $251.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $54.95 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $186.21 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $56.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $190.55 / $275.42