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Louisiana rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $492.46 / $502.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $492.46 / $536.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $882.00 / $1,323.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.00 / $882.00 / $899.64
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.99 / $459.99 / $487.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.29 / $487.59 / $594.86