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Arkansas rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.85 / $1,199.27 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.74 / $799.51 / $993.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,308.46 / $3,308.46 / $3,970.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.39 / $958.75 / $1,065.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.90 / $447.90 / $447.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.01 / $822.69 / $1,201.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,240.00 / $2,311.00 / $5,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.67 / $832.23 / $1,458.51