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Louisiana rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $102.04 / $104.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $102.04 / $121.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.34 / $57.90 / $116.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.01 / $116.01 / $118.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.31 / $95.31 / $101.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.99 / $101.03 / $172.26