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West 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
$73.20 / $137.78 / $305.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.85 / $66.56 / $128.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.50 / $44,999.55 / $123,055.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $92.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.52 / $138.07 / $184.02
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.39 / $86.39 / $86.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $76.58 / $81.34