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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
$1,582.00 / $2,933.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.53 / $788.42 / $1,328.11
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
$538.25 / $717.67 / $834.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.72 / $831.99 / $1,562.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.48 / $913.45 / $5,580.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.72 / $875.17 / $5,627.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,892.00 / $4,545.00 / $7,511.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.80 / $850.34 / $1,184.02