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Tennessee rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.58 / $2,130.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.61 / $28.11 / $38.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $148.00 / $1,676.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.81 / $33.83 / $53.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.73 / $35.08 / $73.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $119.42 / $119.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,210.02 / $2,582.05 / $2,685.33
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
$31.83 / $39.70 / $72.91