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Louisiana rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$197.37 / $1,850.00 / $3,884.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.51 / $159.40 / $219.68
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
$117.91 / $174.59 / $238.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.42 / $101.42 / $101.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.05 / $149.49 / $242.54
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
$149.55 / $186.07 / $313.06