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Michigan 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
$42.66 / $66.07 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $74.13 / $147.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $60.26 / $87.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $131.83 / $269.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $63.10 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $74.13 / $223.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $83.18 / $125.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $77.62 / $81.28