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Missouri rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$684.25 / $3,491.00 / $7,996.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.05 / $821.36 / $1,686.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$848.95 / $848.95 / $848.95
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
$686.00 / $919.60 / $1,422.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.95 / $1,077.47 / $1,818.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.15 / $1,185.00 / $5,764.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.27 / $1,202.21 / $6,925.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $1,697.00 / $3,071.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.39 / $957.77 / $1,713.50