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Michigan rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$697.13 / $839.02 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.75 / $697.13 / $839.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,733.56 / $3,186.06 / $4,316.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.65 / $564.90 / $1,005.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.15 / $675.02 / $2,504.84
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.53 / $2,877.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.79 / $697.13 / $947.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.01 / $483.79 / $801.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.00 / $5,806.00 / $8,884.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.05 / $776.74 / $1,076.99