go back

Montana 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
$85.11 / $85.11 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $79.43 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $46.77
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $46.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $77.62