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Missouri rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; each additional 100 sq cm, 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
$86.31 / $2,832.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.30 / $83.43 / $146.46
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
$84.28 / $103.52 / $157.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.83 / $120.83 / $202.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.33 / $131.93 / $2,019.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.74 / $128.43 / $758.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.00 / $718.00 / $1,795.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.65 / $108.13 / $193.62