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West 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.60 / $164.60 / $164.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.60 / $181.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,999.55 / $44,999.55 / $44,999.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.97 / $175.41 / $175.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.41 / $175.41 / $228.75
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.63 / $243.63 / $243.63
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.03 / $216.03 / $216.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $187.09 / $200.09