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Arkansas rates for HCPCS 90696

Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $66.07 / $109.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $52.48 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $67.61 / $79.43