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Louisiana rates for HCPCS A2015

Phoenix Wound Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $83.18 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $83.18 / $107.15
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,096.48 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $1,445.44 / $1,737.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,318.26 / $1,445.44