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Missouri rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$182.01 / $3,214.00 / $8,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.88 / $153.60 / $722.35
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
$144.08 / $198.90 / $321.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.33 / $218.00 / $394.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.37 / $253.09 / $1,795.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.75 / $269.69 / $2,266.96
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
$174.73 / $226.99 / $396.44