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Louisiana rates for HCPCS 67028

Intravitreal Njx Pharmacologic Agt Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.47 / $941.64 / $3,500.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$727.41 / $727.41 / $923.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.19 / $127.88 / $181.68
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$164.09 / $181.73 / $209.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.55 / $170.55 / $170.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.19 / $699.67 / $1,352.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.22 / $136.37 / $172.31
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.19 / $299.19 / $299.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.00 / $451.00 / $451.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.83 / $126.97 / $288.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $513.00 / $1,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.74 / $123.86 / $293.57