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Louisiana rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $1,513.56 / $4,168.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $257.04 / $416.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $91.20 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $3,090.30 / $7,079.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $288.40 / $354.81
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $269.15 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $288.40 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,162.28 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $281.84 / $446.68