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Louisiana rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $72.27 / $73.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $72.27 / $78.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.84 / $71.84 / $107.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.84 / $71.84 / $73.28
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $67.50 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.98 / $71.55 / $87.29