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Texas rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $2,951.21 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $645.65 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $2,630.27 / $5,248.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $1,096.48
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $794.33 / $1,202.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $28,840.32 / $28,840.32
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,025.60 / $6,025.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $870.96 / $4,265.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $851.14 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $537.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $1,148.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $2,511.89 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $1,023.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31