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Arizona rates for HCPCS 15131

Dermal 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
$1,170.00 / $2,640.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.81 / $88.25 / $145.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.10 / $1,143.18 / $1,810.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.28 / $80.37 / $93.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.56 / $94.32 / $177.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.62 / $102.47 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.04 / $100.10 / $650.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.00 / $1,423.00 / $2,210.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.94 / $97.24 / $128.71