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Missouri rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $2,754.23 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $275.42 / $660.69
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
$190.55 / $275.42 / $457.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $316.23 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $323.59 / $575.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $363.08 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $407.38 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,019.95 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $288.40 / $478.63