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Arkansas rates for HCPCS 15278

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; 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
$91.06 / $1,064.00 / $2,812.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.57 / $75.14 / $106.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.73 / $80.48 / $123.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.31 / $81.73 / $127.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $337.00 / $858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.09 / $96.36 / $170.83