go back

Louisiana rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,729.06 / $3,802.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,729.06 / $4,061.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,078.00 / $3,078.00 / $4,617.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,078.00 / $3,078.00 / $3,139.56
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,483.15 / $3,483.15 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.89 / $292.89 / $292.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,507.53 / $3,692.14 / $4,245.96