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Michigan rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.61 / $1,014.35 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.99 / $840.61 / $1,316.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,108.85 / $5,954.55 / $8,067.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.54 / $722.00 / $1,154.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.01 / $836.90 / $2,962.36
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.61 / $1,065.06 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.82 / $883.68 / $1,331.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.25 / $598.22 / $975.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,433.80 / $3,179.70 / $6,036.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.00 / $986.02 / $1,333.91