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Tennessee rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.00 / $2,303.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.34 / $767.80 / $932.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,917.00 / $3,753.00 / $6,090.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.79 / $837.45 / $1,352.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.72 / $884.49 / $2,134.71
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,006.88 / $5,097.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,264.88 / $5,725.36 / $6,772.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,426.00 / $4,567.00 / $7,604.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.78 / $828.23 / $1,593.88