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Louisiana rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $1,288.25 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $63.10 / $138.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $426.58 / $1,096.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $67.61 / $89.13
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $190.55 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $66.07 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $512.86 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $67.61 / $107.15