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Louisiana rates for HCPCS 90633

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.42 / $40.72 / $76.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.42 / $40.72 / $94.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.14 / $44.14 / $66.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.14 / $44.14 / $45.02
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.18 / $36.18 / $36.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.83 / $43.83 / $43.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.60 / $42.66 / $47.47