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Louisiana rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $1,513.56 / $4,168.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $891.25 / $1,548.82
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $512.86 / $1,258.93