go back

Tennessee rates for HCPCS C5275

Application of low cost 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
$606.00 / $2,311.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $27.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.00 / $1,438.00 / $2,217.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.13 / $612.13 / $612.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $794.00 / $2,577.00