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Arizona rates for HCPCS 15135

Dermal 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
$1,737.80 / $3,715.35 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $2,238.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,778.28 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $724.44 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,548.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $933.25 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $933.25 / $6,456.54
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
$660.69 / $794.33 / $1,122.02