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Virginia 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
$12.88 / $66.07 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $66.07 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $107.15
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $102.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $70.79 / $107.15
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $70.79 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $79.43 / $83.18