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Louisiana rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$377.98 / $1,520.00 / $3,779.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.64 / $314.26 / $476.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.74 / $1,866.58 / $3,899.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.04 / $337.16 / $407.62
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.25 / $302.60 / $472.15
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
$278.67 / $353.32 / $629.90