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Louisiana rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.99 / $13.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.99 / $14.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.70 / $9.73 / $13.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.62 / $13.62 / $13.89
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.60 / $12.86 / $17.30