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Texas rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.00 / $2,514.00 / $7,495.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.09 / $709.46 / $1,043.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,232.96 / $4,495.71 / $8,663.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.20 / $860.88 / $1,267.26
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.70 / $640.70 / $826.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.78 / $872.78 / $1,330.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,006.88 / $16,394.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,264.88 / $5,725.36 / $6,772.43
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.87 / $814.34 / $1,088.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.53 / $1,165.94 / $1,445.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.64 / $827.10 / $1,086.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.87 / $814.94 / $1,161.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.11 / $929.10 / $1,484.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.21 / $826.87 / $1,171.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.39 / $751.91 / $1,047.78