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Arizona rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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
$936.00 / $3,617.00 / $7,467.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.10 / $1,148.72 / $1,810.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.25 / $174.13 / $1,448.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,535.00 / $2,326.00