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Illinois 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
$64.57 / $74.13 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $83.18 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $52.48 / $81.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $223.87 / $851.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $44.67 / $147.91
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $34.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $53.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $251.19 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $75.86 / $79.43