Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
DIPH,PERTUS(ACEL),TET,POL 25 LF-58 MCG-10 LF/0.5 ML IM (UMBRELLA VFC)
Monroe, LA
See all hospitals reporting CPT 90696 →Price type
Brfhh Monroe, Llc’s median price of $69 is 33% below the median hospital's median price ($103), higher than 28% of the 1,532 hospitals reporting CPT 90696. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 13 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna Better Health all payor other · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 2 | Amerihealth Caritas all payor other · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Humana all payor other · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 4 | UnitedHealthcare all payor other · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 5 | UnitedHealthcare all payor percent of total billed charges · outpatientfrom % of charges | $67 | $67 | $6 | 9% | — | $61 – $73 |
| 6 | Bcbs La all payor fee schedule · outpatient | $69 | $69 | — | — | — | $69 – $69 |
| 7 | Cigna all payor other · outpatient | $89 | $89 | — | — | — | $89 – $89 |
| 8 | Cigna all payor other · inpatient | $105 | $105 | — | — | — | $105 – $105 |
| 9 | Aetna all payor other · inpatient | $136 | $136 | — | — | — | $136 – $136 |
| 10 | Aetna all payor other · outpatient | $136 | $136 | — | — | — | $136 – $136 |
| 11 | First Health all payor other · inpatient | $136 | $136 | — | — | — | $136 – $136 |
| 12 | First Health all payor other · outpatient | $136 | $136 | — | — | — | $136 – $136 |
| 13 | MultiPlan all payor other · outpatient | $146 | $146 | — | — | — | $146 – $146 |
Last updated: Apr 1, 2026
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