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North Carolina 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
$42.61 / $66.56 / $170.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.57 / $69.75 / $105.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.30 / $56.30 / $70.06
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 / $74.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.89 / $66.66 / $82.27
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $57.00 / $57.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.43 / $126.36 / $252.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $71.34 / $76.58
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $149.58