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Missouri rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,511.89 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $2,137.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $549.54 / $1,096.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,000.00 / $1,659.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,202.26 / $11,748.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,202.26 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,412.54 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $1,445.44