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Louisiana rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 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
$532.95 / $711.22 / $926.99
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
$668.72 / $838.48 / $988.78
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,846.90 / $1,846.90 / $1,846.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.41 / $728.87 / $1,061.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.00 / $1,629.00 / $4,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.60 / $779.66 / $1,268.43