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Louisiana rates for HCPCS Q4101

Apligraf, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.53 / $2,826.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.53 / $36.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.40 / $33.40 / $50.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.40 / $33.40 / $34.07
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $28.52 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.72 / $30.23 / $36.88