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Missouri rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $2,511.89 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $2,290.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $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
$707.95 / $891.25 / $1,380.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $977.24 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,174.90 / $16,218.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,174.90 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,019.95 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,412.54