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Ohio 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
$64.57 / $95.50 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $74.13 / $165.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $52.48 / $63.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $134.90 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $70.79 / $117.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
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 / $107.15
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $70.79 / $199.53
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $107.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $50.12
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $77.62 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $75.86 / $79.43