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Louisiana rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $28,038.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $121.00 / $121.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.90 / $108.90 / $163.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.90 / $108.90 / $111.08
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.80 / $110.00 / $148.04