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Louisiana rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $28.69 / $28.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.81 / $25.81 / $38.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.81 / $25.81 / $26.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.26 / $28.69 / $31.63