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Louisiana rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.00 / $1,520.00 / $3,728.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.99 / $881.45 / $1,395.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,607.97 / $3,312.82 / $5,168.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.70 / $950.75 / $1,104.48
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,010.01 / $2,010.01 / $2,010.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.85 / $848.88 / $1,239.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $1,752.00 / $4,251.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.18 / $896.47 / $1,511.85