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New York 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
$45.63 / $77.20 / $355.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.89 / $69.89 / $126.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.58 / $64.08 / $64.08
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.64 / $55.64 / $55.64
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.64 / $55.64 / $55.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.19 / $66.12 / $248.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.36 / $70.36 / $70.36
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.31 / $67.31 / $137.99
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.31 / $67.31 / $67.31
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.95 / $65.95 / $65.95
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.95 / $65.95 / $71.05
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.27 / $82.27 / $82.27
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.97 / $79.97 / $82.27
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.12 / $66.12 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.00 / $48.00 / $70.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.70 / $71.98 / $96.42
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.95 / $65.95 / $65.95
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.40 / $65.95 / $71.05