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Louisiana rates for HCPCS A4680

Activated carbon filter for hemodialysis, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.89 / $28.89 / $28.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.54 / $34.11 / $40.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.54 / $34.79 / $35.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.29 / $118.29 / $118.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $36.29 / $36.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.12 / $44.04