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Texas rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.15 / $2,496.00 / $7,316.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.19 / $777.80 / $1,146.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,509.15 / $2,612.61 / $5,501.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.52 / $809.23 / $1,160.51
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.99 / $1,853.20 / $7,090.81
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.36 / $2,010.01 / $2,010.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.86 / $947.77 / $1,433.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,597.37 / $16,394.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,155.28 / $6,224.16 / $7,385.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$671.12 / $882.92 / $1,264.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.18 / $1,184.65 / $1,692.36
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.98 / $877.46 / $1,172.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.93 / $882.92 / $1,272.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.11 / $977.96 / $1,572.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.00 / $2,064.00 / $4,509.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.35 / $896.47 / $1,362.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.19 / $816.57 / $1,141.17