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Texas rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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
$263.14 / $2,872.00 / $10,048.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,336.08 / $2,476.51 / $6,662.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.17 / $98.17 / $194.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.85 / $26,542.00 / $26,542.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.48 / $170.73 / $277.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.48 / $170.73 / $279.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $950.00 / $2,290.00