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Texas rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.71 / $2,124.00 / $7,513.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.95 / $62.71 / $95.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.53 / $1,018.00 / $3,989.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.36 / $68.95 / $127.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.03 / $191.02 / $191.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.93 / $74.51 / $119.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $209.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,932.96 / $3,377.81 / $3,512.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.75 / $65.09 / $102.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.96 / $84.74 / $143.18
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.41 / $74.12 / $101.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.75 / $65.09 / $102.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.22 / $76.77 / $128.59
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
$58.14 / $81.56 / $122.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.70 / $74.12 / $103.77