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Tennessee rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.77 / $2,311.00 / $6,681.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.78 / $710.22 / $974.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,662.00 / $2,859.00 / $3,766.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.90 / $843.88 / $1,328.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.47 / $886.98 / $1,963.71
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,149.72 / $3,402.71 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,868.39 / $6,049.44 / $7,128.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.00 / $3,616.00 / $6,003.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.20 / $905.43 / $1,615.32