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Texas rates for HCPCS 15111

Epidermal 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
$159.01 / $2,128.00 / $7,316.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.98 / $786.56 / $3,989.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.76 / $88.76 / $121.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.03 / $12,000.00 / $12,000.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.87 / $120.37 / $180.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.27 / $120.46 / $188.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $950.00 / $2,290.00