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Missouri rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.97 / $3,213.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.21 / $657.46 / $1,952.31
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
$574.00 / $744.53 / $1,149.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.86 / $855.12 / $1,460.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.67 / $980.86 / $5,764.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.36 / $995.81 / $5,728.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.00 / $2,054.00 / $3,004.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.16 / $817.05 / $1,424.46