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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 / $66.07 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $66.07 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $60.26 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $72.44
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $162.18 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $74.13 / $79.43