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Missouri rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.90 / $3,362.00 / $7,996.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.88 / $717.46 / $2,117.58
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
$583.98 / $785.12 / $1,221.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.03 / $939.53 / $1,617.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.37 / $1,076.19 / $7,354.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.95 / $1,079.66 / $6,214.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,644.00 / $2,874.00 / $5,813.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.55 / $928.85 / $1,603.69