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New Jersey 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
$35.64 / $66.56 / $66.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.83 / $59.83 / $59.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.36 / $70.36 / $75.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.08 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.57 / $63.57 / $63.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $71.98 / $76.58