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New Mexico 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
$74.13 / $74.13 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $72.44 / $100.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $100.00 / $100.00
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
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $72.44 / $144.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $77.62 / $79.43