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Louisiana rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $661.85 / $674.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $661.85 / $720.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.17 / $1,034.17 / $1,551.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.17 / $1,034.17 / $1,054.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $618.21 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.64 / $655.29 / $819.13