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Louisiana rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.95 / $8.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.95 / $9.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.95 / $7.95 / $11.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $7.95 / $8.11
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.43 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $7.87 / $8.68