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Louisiana rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $53.28 / $54.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $53.28 / $63.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.76 / $35.09 / $56.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.97 / $56.97 / $58.11
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.77 / $49.77 / $52.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $52.75 / $58.66