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Louisiana rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $8,913.54 / $28,691.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $31.11 / $31.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.72 / $33.04 / $38.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $34.22 / $34.90
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.56 / $31.11 / $34.29