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Arizona rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.47 / $1,968.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $134.77 / $257.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,211.19 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.64 / $97.88 / $151.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.34 / $143.22 / $230.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.60 / $150.90 / $2,453.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.88 / $163.80 / $3,179.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,578.00 / $2,522.00 / $5,029.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.43 / $154.69 / $217.77