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Massachusetts 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 / $66.07 / $66.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $72.44 / $218.78
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $154.88 / $204.17
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $64.57 / $79.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $147.91
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $66.07 / $120.23
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.81 / $0.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $154.88 / $204.17
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $64.57 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $251.19 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $79.43 / $97.72