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Louisiana rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.00 / $1,520.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.87 / $841.84 / $1,047.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,762.13 / $3,312.82 / $5,168.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.87 / $889.44 / $1,139.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.79 / $838.27 / $1,212.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.00 / $1,629.00 / $4,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.78 / $864.89 / $1,453.80