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Arkansas rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.15 / $1,295.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.79 / $126.69 / $171.90
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
$94.30 / $138.68 / $210.99
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.22 / $151.22 / $151.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.52 / $139.29 / $234.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.00 / $1,263.00 / $2,558.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.66 / $169.76 / $268.27