go back

Louisiana rates for HCPCS Q4205

Membrane Graft Or Membrane Wrap Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,237.28 / $1,249.66 / $1,274.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,249.66 / $1,361.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,161.57 / $1,161.57 / $1,742.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.57 / $1,161.57 / $1,184.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.25 / $1,167.25 / $1,237.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.97 / $1,237.28 / $1,427.66