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Missouri rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $3,162.28 / $7,413.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $177.83 / $3,090.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $707.95 / $1,412.54