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Arizona rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$73.51 / $83.62 / $143.34
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
$59.45 / $79.26 / $92.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.31 / $93.61 / $177.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.49 / $101.94 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $97.02 / $650.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,535.00 / $2,326.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.59 / $93.39 / $129.44