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Indiana 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
$66.56 / $91.94 / $146.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.17 / $66.56 / $120.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.95 / $125.64 / $188.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.46 / $64.08 / $90.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.80 / $90.11 / $119.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.80 / $85.82 / $98.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.09 / $70.36 / $188.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $71.98 / $85.09