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Arkansas rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, 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
$75.66 / $1,064.00 / $2,812.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.95 / $59.93 / $75.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $64.19 / $105.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.74 / $64.88 / $108.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $337.00 / $858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.25 / $81.56 / $141.40