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Louisiana rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $71.40 / $72.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $71.40 / $77.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.89 / $80.89 / $121.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.89 / $80.89 / $82.51
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.18 / $70.70 / $88.38