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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
$102.33 / $181.97 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2,570.40 / $3,981.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $676.08 / $1,621.81
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $645.65 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $239.88 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,951.21 / $4,265.80