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Louisiana rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$228.26 / $1,520.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.26 / $186.15 / $252.72
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
$148.25 / $217.79 / $277.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.93 / $183.78 / $289.51
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
$172.71 / $216.14 / $385.17