go back

Arkansas rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, 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
$100.83 / $803.00 / $2,812.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.41 / $100.61 / $129.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.18 / $116.70 / $129.66
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
$59.30 / $104.71 / $153.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $337.00 / $858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.70 / $102.13 / $169.32