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Louisiana rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $158.49 / $190.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $177.83 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $158.49 / $165.96