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Arizona rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$1,582.00 / $2,933.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.12 / $175.82 / $310.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.10 / $1,143.18 / $1,810.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $127.88 / $194.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.53 / $186.47 / $304.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.61 / $195.97 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.36 / $214.20 / $2,266.96
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
$172.94 / $203.66 / $304.33