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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
$42.66 / $72.44 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $66.07 / $154.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $52.48 / $74.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $70.79 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $74.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $66.07 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $251.19 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $74.13 / $79.43
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87