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Tennessee rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, 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
$116.70 / $2,133.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $62.71 / $95.98
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
$41.87 / $69.84 / $111.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.01 / $72.51 / $138.56
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $209.24 / $209.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,932.96 / $3,377.81 / $3,512.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.00 / $784.00 / $2,577.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.03 / $84.01 / $155.16