go back

Arkansas rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.93 / $1,230.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.76 / $731.59 / $890.93
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
$670.29 / $887.15 / $1,105.60
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
$443.74 / $835.16 / $1,163.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$980.00 / $1,650.00 / $4,233.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.90 / $863.62 / $1,416.69