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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
$325.50 / $1,355.25 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.87 / $263.32 / $448.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.74 / $3,116.63 / $7,020.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.61 / $313.30 / $373.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.39 / $266.39 / $266.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.89 / $275.43 / $429.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $3,238.00 / $8,257.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.82 / $322.27 / $542.03