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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
$66.56 / $66.56 / $73.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.23 / $194.23 / $194.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.08 / $64.08 / $64.08
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.57 / $73.55 / $112.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $96.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $63.70 / $95.55