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DTaP And Polio Combination Vaccine

Wisconsin rates for HCPCS 90696

A single injection protecting against four infections at once: diphtheria, tetanus, whooping cough, and polio. Combining them means one needle instead of separate injections for each. The charge covers the vaccine itself; giving the injection is charged separately.

Facilitymedian $66 · 10th–90th $66$1660%50%90th$66Professionalmedian $85 · 10th–90th $66$1820%20%10th90th$85$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$89.13
Typical High
$199.53
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$147.91
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$72.44
Typical High
$77.62
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$74.13
Typical High
$74.13
Medica
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$89.13
Typical High
$208.93
Medica
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$72.44
Typical High
$102.33
Molina
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$54.95
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Quartz
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$223.87
Quartz
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Security Health
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$69.18
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$74.13
Typical High
$107.15