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Missouri rates for HCPCS 15278

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; 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
$120.23 / $2,511.89 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $79.43 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $74.13 / $141.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $97.72 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $95.50 / $162.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $100.00 / $891.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $120.23 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $707.95 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $83.18 / $134.90