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Louisiana rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $135.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $91.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.90 / $160.91 / $177.41