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Arizona rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.00 / $2,300.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.61 / $62.71 / $110.10
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
$35.59 / $44.68 / $75.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.62 / $68.53 / $111.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.34 / $75.08 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.59 / $81.36 / $2,932.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,488.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.54 / $75.84 / $106.48