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Arizona rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,715.35 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $933.25 / $2,238.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $776.25 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,659.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $977.24 / $3,388.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $977.24 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,041.74 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,202.26