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Missouri rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$148.19 / $4,261.00 / $8,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.11 / $135.16 / $383.42
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
$114.00 / $164.96 / $265.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.35 / $184.87 / $339.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.71 / $214.03 / $1,795.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.47 / $230.57 / $1,925.20
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
$149.55 / $196.29 / $335.28