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Utah 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
$56.23 / $66.07 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $66.07 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $67.61 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $75.86 / $77.62