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Pennsylvania 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
$53.70 / $66.07 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $79.43 / $177.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $52.48 / $66.07
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $79.43 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
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 / $70.79
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $66.07 / $112.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $79.43 / $199.53
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $60.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $79.43 / $97.72