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Texas rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.26 / $2,496.00 / $7,316.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $683.90 / $1,022.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,444.24 / $2,563.92 / $4,981.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.35 / $716.46 / $1,053.57
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.47 / $907.51 / $4,500.00
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.29 / $780.23 / $1,061.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.65 / $1,846.90 / $1,846.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.95 / $820.38 / $1,263.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,200.78 / $16,394.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,435.20 / $5,573.28 / $6,506.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.13 / $767.32 / $1,101.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.99 / $1,025.99 / $1,397.03
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.25 / $752.55 / $994.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.13 / $766.75 / $1,128.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.79 / $852.89 / $1,388.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$745.00 / $2,494.00 / $4,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.94 / $795.02 / $1,206.53
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.03 / $723.76 / $1,013.26