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Louisiana rates for HCPCS 90634

Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.75 / $30.75 / $30.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $30.75 / $30.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.01 / $26.01 / $39.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.01 / $26.01 / $26.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.85 / $24.28 / $29.14