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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
$275.51 / $3,213.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.53 / $263.32 / $487.12
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
$184.23 / $267.95 / $454.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.90 / $324.14 / $563.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.62 / $334.91 / $3,700.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.37 / $395.10 / $3,837.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,708.00 / $3,502.00 / $6,944.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.74 / $346.74 / $573.76