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Arizona rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.00 / $2,912.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.78 / $927.90 / $1,626.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.53 / $909.53 / $1,072.29
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
$612.70 / $814.01 / $962.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.34 / $925.29 / $1,764.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$793.13 / $972.90 / $3,047.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.24 / $997.50 / $7,470.40
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
$803.22 / $969.00 / $1,282.50