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Georgia 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 / $83.18 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $66.07 / $97.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $52.48 / $61.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $72.44 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $109.65 / $109.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $302.00 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $79.43 / $114.82