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Iowa 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 / $74.13 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $95.50 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $63.10 / $75.86
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $36.31 / $147.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $74.13 / $112.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $72.44 / $75.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $74.13 / $79.43
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10