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Louisiana rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,513.56 / $4,168.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $1,380.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $4,786.30 / $7,079.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $831.76 / $1,023.29
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $2,818.38 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $891.25 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,467.37 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,288.25