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Missouri rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.56 / $2,076.00 / $5,687.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.70 / $134.77 / $392.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $79.00 / $79.00
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
$90.05 / $139.90 / $236.07
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$135.07 / $209.85 / $354.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.52 / $167.70 / $273.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.71 / $169.54 / $2,442.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.99 / $198.30 / $3,593.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $2,261.00 / $3,074.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.33 / $165.22 / $282.31