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Arizona rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $2,884.03 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $851.14 / $2,041.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,819.70 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $1,479.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $891.25 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $4,073.80 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $776.25 / $1,096.48