go back

Louisiana rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.18 / $1,744.00 / $3,945.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.27 / $829.85 / $1,083.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,607.97 / $3,312.82 / $5,168.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.65 / $918.39 / $1,070.03
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.67 / $806.24 / $1,161.67
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
$690.90 / $859.55 / $1,331.59