go back

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
$66.56 / $66.56 / $102.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $81.20
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.80 / $150.24 / $204.74
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $71.98 / $78.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.25 / $95.43 / $203.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.03 / $63.57 / $134.77
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $0.82 / $0.82
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $149.58
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $76.58 / $95.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $76.58 / $89.18