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Missouri rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.32 / $2,507.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $27.91 / $51.89
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
$22.08 / $31.68 / $51.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.89 / $38.33 / $63.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.50 / $46.31 / $875.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $43.53 / $2,582.05
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
$28.30 / $38.69 / $63.67