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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
$758.58 / $1,659.59 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $977.24 / $1,621.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $812.83 / $1,445.44
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
$870.96 / $1,000.00 / $1,174.90
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,047.13 / $1,548.82
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
$741.31 / $933.25 / $1,479.11