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Arizona 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
$36.31 / $38.02 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $89.13 / $213.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $52.48 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $169.82 / $251.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $120.23 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $74.13 / $95.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $75.86 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $77.62 / $79.43