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Louisiana rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.64 / $149.69 / $195.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.64 / $140.08 / $216.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.05 / $137.94 / $219.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.76 / $132.27 / $222.59