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Arizona rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,251.00 / $2,897.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $711.22 / $1,022.36
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
$441.41 / $586.44 / $738.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.14 / $726.26 / $1,289.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.79 / $745.28 / $3,047.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.12 / $775.89 / $5,728.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,283.00 / $2,399.00 / $4,850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.45 / $747.32 / $1,042.51