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Tennessee rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.54 / $2,303.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.96 / $268.68 / $402.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,610.00 / $2,753.00 / $3,681.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.42 / $319.18 / $516.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.79 / $324.58 / $655.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,507.44 / $1,536.60
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.84 / $2,434.08 / $2,871.68
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
$282.66 / $370.99 / $698.67