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Arizona rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.61 / $2,788.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.06 / $263.32 / $419.14
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
$157.56 / $186.80 / $289.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.08 / $284.39 / $453.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.97 / $288.27 / $5,580.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.83 / $322.27 / $3,405.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.00 / $4,545.00 / $7,217.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.72 / $312.55 / $627.12