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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
$74.79 / $74.79 / $74.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.70 / $71.22 / $100.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $100.72 / $100.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.00 / $59.25 / $70.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.98 / $76.58 / $76.58