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Minnesota 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
$103.01 / $181.63 / $4,828.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $88.11 / $3,644.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.14 / $642.61 / $1,545.88
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.80 / $587.50 / $1,217.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.01 / $231.90 / $474.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00