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Texas rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.41 / $2,550.00 / $7,495.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.31 / $616.14 / $963.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,460.47 / $2,568.40 / $4,940.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.97 / $695.05 / $1,008.30
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.46 / $535.46 / $746.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.67 / $766.39 / $1,139.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,046.94 / $16,394.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,326.32 / $5,170.88 / $6,114.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.54 / $723.82 / $1,012.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.60 / $982.24 / $1,304.98
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.70 / $725.04 / $982.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.54 / $723.82 / $1,052.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.47 / $793.73 / $1,240.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,124.00 / $3,314.00 / $7,600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.53 / $744.47 / $1,066.65
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.79 / $675.91 / $946.27