go back

Missouri 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
$66.56 / $89.64 / $99.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.00 / $66.56 / $87.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.47 / $106.79 / $165.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.70 / $72.70 / $72.70
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $80.00 / $272.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $75.17 / $77.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $75.17 / $77.04