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Louisiana rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $173.78 / $208.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $204.17 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $190.55 / $204.17