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Louisiana rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $112.26 / $114.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $112.26 / $122.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.66 / $365.66 / $548.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.66 / $365.66 / $372.97
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $104.86 / $111.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.61 / $111.15 / $149.58