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Louisiana rates for HCPCS 15278

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; 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
$102.93 / $1,236.00 / $3,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.07 / $80.04 / $113.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.55 / $849.12 / $1,192.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.59 / $87.37 / $106.10
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.82 / $78.95 / $127.71
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
$74.86 / $96.36 / $160.72