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Arizona rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,090.30 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $1,995.26
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
$489.78 / $660.69 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $1,479.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $851.14 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $5,888.44
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
$588.84 / $724.44 / $1,047.13