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Texas rates for HCPCS 15152

Tissue cultured skin 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
$225.42 / $2,128.00 / $7,316.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.53 / $575.53 / $3,790.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.10 / $120.10 / $155.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.69 / $12,000.00 / $12,000.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.74 / $165.49 / $237.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.26 / $165.60 / $250.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $950.00 / $2,290.00