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Michigan rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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
$130.52 / $215.72 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.02 / $2,156.27 / $2,921.40
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.22 / $4,112.00 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $1,418.00 / $2,449.00