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Louisiana rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $742.40 / $757.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $742.40 / $808.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.52 / $1,028.52 / $1,542.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.52 / $1,028.52 / $1,049.08
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.37 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.44 / $693.44 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.42 / $735.05 / $918.81