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Louisiana rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $85.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $83.18 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89