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Louisiana rates for HCPCS Q4165

Keramatrix Or Kerasorb Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.24 / $53.24 / $53.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $53.24 / $53.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.38 / $32.38 / $48.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.38 / $32.38 / $33.03
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.84 / $100.84 / $100.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.15 / $44.36 / $92.61