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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
$66.07 / $93.33 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $72.44 / $109.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $60.26 / $61.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $107.15 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $70.79 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $79.43 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $75.86 / $77.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $75.86 / $79.43