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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
$103.30 / $3,213.00 / $7,365.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,958.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.67 / $175.37 / $1,795.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $875.00 / $1,300.00