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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
$61.95 / $66.56 / $81.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.70 / $80.00 / $139.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $92.44 / $151.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.28 / $65.34 / $65.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.14 / $194.69 / $237.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.74 / $73.51 / $77.63
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.59 / $177.67 / $222.98
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.13 / $61.13 / $85.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.00 / $73.86 / $142.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $70.06 / $83.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $70.06 / $94.48