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Arizona rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$1,582.00 / $2,912.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.15 / $281.06 / $554.20
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
$181.55 / $211.05 / $323.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.94 / $309.70 / $502.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.39 / $322.47 / $2,421.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.27 / $350.40 / $1,622.24
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
$280.32 / $323.07 / $499.31