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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
$691.83 / $3,162.28 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $2,238.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,258.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,071.52 / $1,778.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,230.27 / $11,748.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,230.27 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,412.54 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $933.25 / $1,548.82