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Tennessee rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.64 / $2,259.73 / $6,681.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.05 / $785.28 / $1,136.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,610.00 / $2,753.00 / $3,681.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.90 / $884.63 / $1,371.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.97 / $923.51 / $2,089.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,339.76 / $3,597.37 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,155.28 / $6,224.16 / $7,385.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.00 / $2,260.00 / $4,099.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.97 / $999.58 / $1,710.68