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Arizona rates for HCPCS 15278

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; 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
$1,445.44 / $3,090.30 / $6,309.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $79.43 / $234.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $51.29 / $91.20
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
$45.71 / $63.10 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $81.28 / $141.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $97.72 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $102.33 / $6,025.60
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
$51.29 / $77.62 / $114.82