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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
$74.79 / $74.79 / $242.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $74.79 / $100.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.98 / $154.34 / $304.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.50 / $73.50 / $73.50
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $149.58 / $272.63
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.34 / $73.04 / $96.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.79 / $74.79 / $106.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $120.00 / $120.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.53 / $70.36 / $106.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.52 / $75.17 / $76.58
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.30 / $62.30 / $84.11