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Louisiana rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $1,200.00 / $1,200.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.08 / $93.96 / $899.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.99 / $899.99 / $917.99
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.90 / $78.90 / $78.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.67 / $788.99 / $869.86