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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
$63.89 / $66.56 / $87.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.50 / $77.34 / $118.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.22 / $137.31 / $259.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.68 / $59.68 / $62.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.87 / $70.36 / $70.36
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.89 / $66.56 / $74.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.70 / $69.09 / $108.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $76.44 / $91.90