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Louisiana rates for HCPCS Q4103

Oasis burn matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.62 / $12.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.62 / $13.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.78 / $13.78 / $20.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.78 / $13.78 / $14.06
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $11.78 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.87 / $12.49 / $15.24