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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
$1,582.00 / $2,912.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.96 / $690.41 / $1,195.19
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
$491.75 / $655.66 / $762.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.08 / $745.94 / $1,488.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.47 / $834.57 / $5,580.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.44 / $784.04 / $5,361.44
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
$617.40 / $758.99 / $1,037.71