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Louisiana rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $98.92 / $100.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $98.92 / $117.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.60 / $73.44 / $110.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.19 / $110.19 / $112.39
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.40 / $92.40 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.06 / $97.94 / $166.99