go back

Louisiana rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $562.34 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $2,818.38 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,454.71 / $2,818.38