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Arkansas rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$877.00 / $1,230.00 / $3,894.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.40 / $871.49 / $1,009.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,400.41 / $1,400.41 / $1,400.41
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
$797.54 / $1,055.57 / $1,232.24
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
$589.04 / $946.45 / $1,312.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.00 / $1,263.00 / $2,539.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.12 / $957.46 / $1,579.85