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Tennessee rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.23 / $2,303.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.21 / $733.47 / $940.88
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
$640.00 / $882.19 / $1,312.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.41 / $890.14 / $2,032.75
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,806.47 / $4,882.08 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,082.96 / $5,877.44 / $6,859.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.00 / $2,260.00 / $4,035.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.86 / $860.18 / $1,600.46