go back

Maine 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
Professional
Modifier
Low / Median / High Price
$64.57 / $77.62 / $109.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $75.86 / $85.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $69.18 / $109.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $64.57 / $112.20