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Missouri rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$85.14 / $2,832.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.34 / $82.31 / $144.65
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
$79.05 / $99.31 / $153.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.83 / $120.51 / $195.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.33 / $130.68 / $2,019.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.42 / $125.79 / $758.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $815.00 / $1,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.59 / $107.22 / $182.72