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Louisiana rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.47 / $1,142.00 / $3,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $32.64 / $42.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.38 / $312.88 / $439.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.59 / $35.60 / $41.06
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.21 / $33.86 / $47.86
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
$28.87 / $35.36 / $62.64