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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
$13.02 / $66.56 / $105.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $113.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.08 / $64.08 / $64.08
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.58 / $76.58 / $76.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.79 / $74.79 / $101.37
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.31 / $71.05 / $92.47
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.31 / $71.05 / $92.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $76.58 / $76.58