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Louisiana rates for HCPCS Q4259

Celera Dual Layer or Celera Dual Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $720.64 / $734.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $720.64 / $784.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,072.79 / $1,072.79 / $1,609.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.79 / $1,072.79 / $1,094.25
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $673.11 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,189.82 / $1,189.82 / $1,189.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.94 / $713.50 / $960.22