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Louisiana rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $101.13 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $101.13 / $101.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.01 / $91.01 / $136.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.01 / $91.01 / $92.83
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.66 / $136.47 / $150.46