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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
$28.18 / $28.18 / $28.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $33.88 / $42.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $34.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $53.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.12 / $46.77