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Louisiana rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $1,288.25 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $95.50 / $138.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $2,041.74 / $5,248.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $102.33 / $112.20
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $109.65 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $512.86 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $95.50 / $151.36