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Minnesota rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$125.14 / $203.77 / $4,828.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $105.39 / $3,930.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.04 / $719.05 / $1,729.77
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.19 / $657.38 / $1,362.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.54 / $277.77 / $571.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00