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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
$70.79 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $66.07 / $85.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $52.48 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $70.79 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $74.13 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $74.13 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $75.86 / $79.43