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Louisiana rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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 / $1,372.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.09 / $737.09 / $937.84
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
$656.11 / $766.44 / $875.17
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.16 / $702.98 / $1,014.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.00 / $2,415.00 / $6,585.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.55 / $707.30 / $1,206.20