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Louisiana rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.93 / $21.31 / $38.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.15 / $22.00 / $26.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.56 / $111.81 / $182.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.19 / $23.95 / $29.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.83 / $11.45 / $31.92