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Arkansas rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.86 / $1,064.00 / $2,812.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $28.42 / $37.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.98 / $33.07 / $42.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.34 / $33.19 / $53.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $328.00 / $858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.17 / $37.40 / $62.59