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Texas rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.36 / $2,500.00 / $7,542.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.11 / $251.53 / $376.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,322.29 / $4,503.00 / $8,872.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.27 / $263.95 / $494.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.62 / $266.39 / $311.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.29 / $314.26 / $458.68
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $931.67
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,405.33 / $3,837.16 / $3,990.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.67 / $279.60 / $410.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.11 / $368.75 / $548.70
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.99 / $284.77 / $395.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.67 / $279.64 / $413.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.33 / $326.58 / $522.92
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
$239.30 / $322.27 / $474.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.77 / $284.77 / $398.07