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Maryland 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 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $70.79 / $213.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $74.13 / $79.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66