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Texas rates for HCPCS 15272

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $2,020.00 / $6,762.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.77 / $19.77 / $30.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.47 / $467.43 / $3,989.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.08 / $22.28 / $37.06
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.49 / $70.88 / $70.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.46 / $26.11 / $41.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $80.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,376.87 / $3,779.26 / $3,930.43
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.95 / $23.09 / $34.34
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.21 / $30.08 / $43.91
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.83 / $22.89 / $31.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.95 / $23.09 / $34.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.95 / $27.23 / $45.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $952.00 / $2,405.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.54 / $27.39 / $43.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.14 / $22.89 / $31.93