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Arizona rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,090.30 / $6,760.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $1,023.29 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $141.25 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,230.27 / $2,187.76