go back

Minnesota 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 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $75.86 / $138.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $131.83 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $66.07 / $67.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $204.17 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $74.13 / $77.62
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $194.98 / $229.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $74.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $74.13 / $141.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $70.79 / $83.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $70.79 / $100.00