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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)

Facilitymedian $2,188 · 10th–90th $407–$5,6230%10%10th90th$2,188Professionalmedian $89 · 10th–90th $72–$2240%10%20%10th90th$89$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $3,090.30 / $6,309.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $89.13 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $1,230.27 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $79.43 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $93.33 / $162.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $104.71 / $758.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,122.02 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $91.20 / $134.90