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Louisiana rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,989.59 / $2,028.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,989.59 / $2,166.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,431.08 / $2,431.08 / $3,646.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,431.08 / $2,431.08 / $2,479.69
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,858.38 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $225.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,871.71 / $1,969.89 / $2,296.84