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Connecticut 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 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $66.07 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $100.00 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
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
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $77.62 / $77.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $72.44