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Arizona rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$501.23 / $616.14 / $1,085.26
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
$433.43 / $575.84 / $688.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.86 / $658.42 / $1,208.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.54 / $744.03 / $3,751.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.90 / $707.30 / $4,406.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,343.00 / $3,339.00 / $5,838.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.35 / $701.42 / $954.17