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Idaho 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
$66.07 / $77.62 / $141.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $56.23 / $63.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $63.10 / $87.10
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $67.61 / $125.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $77.62 / $79.43