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Louisiana rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,318 · 10th–90th $347–$1,3180%50%10th$1,318Professionalmedian $1,230 · 10th–90th $126–$1,3490%20%40%10th90th$1,230$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,258.93 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,348.96
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,318.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,318.26
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $239.88 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $1,047.13 / $1,288.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $1,047.13