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Missouri rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$95.24 / $3,213.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $111.08 / $246.70
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
$73.00 / $113.75 / $196.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.86 / $129.83 / $254.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.26 / $162.04 / $1,795.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.74 / $170.30 / $1,510.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $815.00 / $1,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.45 / $147.54 / $249.76