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Tennessee rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.50 / $2,133.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.41 / $95.14 / $112.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $147.00 / $1,676.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.59 / $102.20 / $159.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.37 / $110.87 / $261.63
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.21 / $436.76 / $12,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.40 / $758.33 / $819.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $794.00 / $2,577.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.42 / $109.28 / $196.16