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Missouri rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.28 / $3,214.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.12 / $683.71 / $1,175.11
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
$589.00 / $785.05 / $1,257.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.78 / $935.77 / $1,564.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.79 / $1,073.13 / $11,536.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.53 / $1,023.77 / $5,854.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.00 / $3,502.00 / $6,854.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.95 / $833.85 / $1,474.66