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Louisiana rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.83 / $1,319.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.90 / $137.75 / $226.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.97 / $1,698.68 / $3,899.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.16 / $162.25 / $191.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,653.23 / $1,653.23 / $1,653.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.93 / $139.19 / $214.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.00 / $1,429.00 / $4,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.41 / $161.68 / $267.00