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Louisiana rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $670.26 / $683.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $670.26 / $729.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.00 / $253.44 / $791.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.31 / $791.31 / $807.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.05 / $626.05 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.54 / $663.63 / $849.92