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Arizona rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.00 / $2,933.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.71 / $738.60 / $1,210.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,283.06 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.97 / $669.29 / $778.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.12 / $779.65 / $1,427.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.48 / $842.72 / $3,047.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.40 / $822.25 / $5,163.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,283.00 / $2,399.00 / $4,850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.82 / $792.67 / $1,120.88