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Louisiana rates for HCPCS Q4124

OASIS ultra tri-layer 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
$2.49 / $2.50 / $2.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.50 / $2.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $10.51 / $13.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.19
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.35 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.49 / $3.11