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Louisiana rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.00 / $1,520.00 / $3,884.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.11 / $1,015.24 / $1,631.71
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
$923.33 / $1,088.91 / $1,315.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.38 / $821.38 / $821.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.79 / $989.28 / $1,479.59
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
$819.71 / $993.36 / $1,602.19