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Louisiana rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $66.06 / $67.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $66.06 / $76.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.95 / $71.95 / $107.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.95 / $71.95 / $73.39
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.70 / $61.70 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.15 / $65.41 / $94.75