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Texas rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $3,019.95 / $7,943.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,819.70 / $3,981.07
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $144.54
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $28,840.32 / $28,840.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $158.49 / $3,715.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $125.89 / $218.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $1,047.13 / $2,691.53