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Arizona rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, 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
$21.10 / $29.26 / $42.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.80 / $1,100.28 / $1,810.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.43 / $23.50 / $31.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.91 / $32.64 / $53.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.51 / $34.19 / $1,448.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.38 / $35.64 / $2,210.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $34.29 / $46.53