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Minnesota rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$660.69 / $812.83 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,949.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $7,244.36 / $16,595.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,737.80 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $3,090.30 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,344.23 / $3,548.13
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,951.21 / $5,888.44
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $3,311.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,230.27 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,584.89 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $6,025.60 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,412.54 / $2,691.53