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Texas rates for HCPCS 15276

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$37.58 / $2,017.00 / $6,762.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $28.54 / $40.51
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
$22.78 / $30.18 / $45.56
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.49 / $23.49 / $46.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.76 / $21.76 / $34.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.27 / $35.24 / $54.18
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $119.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,210.02 / $2,582.05 / $2,685.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.66 / $30.85 / $45.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.93 / $42.88 / $58.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.49 / $31.18 / $41.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.66 / $30.82 / $45.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.22 / $37.08 / $59.61
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
$26.73 / $35.36 / $53.92
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.05 / $30.82 / $42.84