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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
$1,548.17 / $3,641.50 / $6,305.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.01 / $856.37 / $1,403.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.35 / $2,531.19 / $4,140.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.25 / $766.05 / $893.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.34 / $864.86 / $1,657.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$745.97 / $915.18 / $3,093.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.28 / $928.55 / $6,925.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.00 / $2,567.00 / $5,105.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.40 / $902.02 / $1,262.46