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Arizona rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$1,965.00 / $3,819.00 / $7,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.89 / $149.00 / $261.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.60 / $1,308.38 / $2,072.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.99 / $106.26 / $164.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.96 / $154.97 / $244.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.59 / $163.90 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.96 / $183.75 / $1,925.20
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
$150.22 / $176.12 / $236.98