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Tennessee rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.46 / $1,855.00 / $5,188.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.91 / $129.46 / $188.16
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$587.47 / $587.47 / $587.47
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
$92.12 / $148.41 / $235.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.69 / $148.08 / $293.45
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $639.72 / $650.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,179.06 / $3,593.56 / $3,737.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.00 / $2,297.00 / $4,099.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.77 / $175.11 / $330.15