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Tennessee rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,621.81 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $1,819.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $588.84 / $1,202.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $4,073.80 / $5,888.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $933.25 / $2,041.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $28,840.32
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $7,079.46 / $7,079.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $4,570.88 / $7,585.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,479.11