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Louisiana rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,949.84 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,445.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,019.95 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $954.99 / $1,096.48
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,479.11 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,348.96