go back

Arizona rates for HCPCS 15157

Tissue cultured skin 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
$135.04 / $152.72 / $259.27
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
$108.47 / $144.63 / $168.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.85 / $180.25 / $310.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.72 / $190.25 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.21 / $184.45 / $1,168.40
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
$149.85 / $176.46 / $233.56