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Texas rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Facilitymedian $2,818 · 10th–90th $724–$8,3180%5%10th90th$2,818Professionalmedian $813 · 10th–90th $589–$1,5140%10%10th90th$813$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $2,570.40 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $831.76 / $1,584.89
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $602.56 / $812.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $4,786.30 / $9,120.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $691.83 / $1,096.48
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $2,818.38 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $954.99 / $1,445.44
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,964.78 / $28,840.32 / $28,840.32
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,165.95 / $7,079.46 / $7,079.46
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,000.00 / $3,890.45
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,023.29 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $676.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $891.25 / $1,348.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $977.24 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $4,786.30 / $9,120.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $812.83 / $1,174.90
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $891.25