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Missouri rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$305.55 / $3,214.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.07 / $290.08 / $496.01
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
$191.25 / $280.20 / $461.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.54 / $354.92 / $615.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.33 / $368.12 / $2,442.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.20 / $433.39 / $2,508.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,216.00 / $2,261.00 / $3,074.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.99 / $380.34 / $638.02