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Tennessee rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$614.29 / $2,303.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.94 / $626.73 / $839.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,610.00 / $2,800.00 / $3,710.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.28 / $724.43 / $1,143.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.54 / $768.31 / $1,744.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,796.08 / $3,046.94 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,326.32 / $5,170.88 / $6,114.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,695.00 / $3,546.00 / $6,003.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.25 / $781.76 / $1,426.09