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Louisiana 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
$0.91 / $66.56 / $110.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $116.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.05 / $71.05 / $106.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.05 / $71.05 / $72.47
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.26 / $71.98 / $76.58