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Hawaii 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
Professional
Modifier
Low / Median / High Price
$64.80 / $91.50 / $215.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $69.20 / $69.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.89 / $76.58 / $95.55
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.09 / $61.28 / $65.31