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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
$36.40 / $37.86 / $129.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.80 / $83.86 / $198.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.58 / $217.23 / $342.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.13 / $59.83 / $396.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $74.79 / $95.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.98 / $76.44 / $76.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.98 / $76.44 / $76.58