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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
$1,230.27 / $2,818.38 / $6,309.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $67.61 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $41.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $891.25 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $52.48 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $69.18 / $114.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $83.18 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $87.10 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,412.54 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $64.57 / $95.50