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Louisiana rates for HCPCS Q4113

GRAFTJACKET XPRESS, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $741.31 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $1,995.26 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,995.26 / $2,041.74