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North Dakota 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 / $66.07 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $70.79 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $75.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $199.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $70.79 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $70.79 / $79.43