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Arkansas rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.86 / $1,277.00 / $3,804.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.82 / $284.85 / $405.31
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
$220.98 / $324.97 / $448.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.34 / $312.62 / $463.64
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
$289.36 / $353.32 / $617.71