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Louisiana rates for HCPCS Q4133

Grafix Prime Grafixpl Prime Stravix And Stravixpl Per Square Centimeter (Desc Rvsd 1/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $140.13 / $142.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $140.13 / $166.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.89 / $154.49 / $200.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.01 / $150.01 / $153.01
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $130.88 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $138.74 / $239.70