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Texas rates for HCPCS 15135

Dermal 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,951.21 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,288.25
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $977.24 / $1,479.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $28,840.32 / $28,840.32
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $7,413.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $977.24 / $4,265.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,621.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $707.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $891.25 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,023.29 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $5,248.07 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,230.27
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96