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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
$762.00 / $1,850.00 / $3,813.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.30 / $919.85 / $1,351.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,607.97 / $3,022.03 / $4,304.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.91 / $1,013.49 / $1,226.24
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.55 / $766.55 / $766.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.68 / $933.12 / $1,376.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.00 / $1,429.00 / $4,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.97 / $941.61 / $1,582.96