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Louisiana rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

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
$522.79 / $856.11 / $1,033.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,829.62 / $4,819.04 / $7,020.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.14 / $851.74 / $966.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.71 / $843.11 / $1,230.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $3,238.00 / $8,257.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.75 / $800.10 / $1,268.02