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Missouri rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.38 / $2,832.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.27 / $62.71 / $95.98
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
$38.97 / $62.71 / $108.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.03 / $81.66 / $134.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $83.36 / $875.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.45 / $98.71 / $3,377.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $875.00 / $1,351.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.70 / $87.65 / $141.27