go back

New Hampshire 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
$66.07 / $66.07 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $154.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $131.83 / $229.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $66.07 / $75.86
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $109.65 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $64.57 / $79.43