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Arkansas rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $741.31 / $1,737.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,023.29 / $1,047.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $851.14 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $870.96 / $1,230.27
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,951.21 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,318.26