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Texas 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
$67.61 / $91.20 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $74.13 / $158.49
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $52.48 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $151.36 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $85.11 / $213.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $74.13 / $147.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $87.10 / $229.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $75.86 / $79.43