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Minnesota 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
$680.41 / $840.74 / $2,891.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.41 / $840.74 / $1,302.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,023.82 / $3,546.93 / $6,480.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.18 / $1,764.36 / $2,973.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.44 / $3,002.81 / $7,223.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,364.40 / $2,326.44 / $3,622.74
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.34 / $2,745.29 / $5,687.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.30 / $2,057.71 / $3,405.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.07 / $1,262.18 / $2,523.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.12 / $1,693.50 / $5,262.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,523.00 / $4,637.00 / $6,361.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.66 / $1,524.00 / $2,992.78