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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
$39.81 / $57.54 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $39.81 / $50.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $36.31 / $38.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $45.71
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $44.67 / $51.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $42.66 / $47.86