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Missouri rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.49 / $3,214.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.14 / $688.74 / $1,203.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,958.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.84 / $845.27 / $1,280.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.48 / $963.32 / $1,630.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.91 / $1,057.97 / $5,764.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.65 / $1,030.35 / $6,003.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.00 / $2,054.00 / $3,004.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.43 / $904.88 / $1,484.78