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Oklahoma 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
$71.89 / $71.89 / $71.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.89 / $71.89 / $73.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.76 / $70.36 / $70.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.24 / $74.79 / $272.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.52 / $75.17 / $76.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.52 / $75.17 / $76.58