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Oregon 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
$63.10 / $66.07 / $66.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $77.62 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $95.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $77.62 / $154.88
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $95.50 / $186.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $72.44 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $77.62 / $79.43