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Louisiana rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$145.84 / $1,520.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.41 / $111.87 / $161.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$829.71 / $1,183.39 / $1,662.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.06 / $112.04 / $175.52
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.17 / $105.87 / $177.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $513.00 / $1,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.45 / $139.31 / $241.80