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Arkansas rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.72 / $1,181.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.51 / $159.32 / $197.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.20 / $156.18 / $228.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.90 / $447.90 / $447.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.84 / $160.59 / $267.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $330.00 / $858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.55 / $186.94 / $306.43