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Louisiana rates for HCPCS A4774

Ammonia test strips, for dialysis, per 50

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $3.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.20 / $4.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $6.50 / $6.50