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Arkansas rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.60 / $1,083.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.94 / $599.71 / $906.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,755.26 / $1,755.26 / $2,106.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.16 / $763.88 / $918.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.03 / $1,620.03 / $1,620.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.94 / $715.54 / $999.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$980.00 / $1,650.00 / $4,064.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.62 / $744.53 / $1,296.40