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Montana rates for HCPCS 90696

Dtap-Ipv Vaccine Child 4-6 Yrs For Im Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.50 / $85.50 / $85.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.50 / $75.88 / $118.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.48 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $73.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.98 / $71.98 / $76.44