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Louisiana rates for HCPCS J3260

Injection Tobramycin Sulfate Up To 80 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $6.15 / $28.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.40 / $2.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.76 / $2.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $1.76 / $1.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.37 / $2.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.37 / $4.95