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Michigan rates for HCPCS 15131

Dermal 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
$105.78 / $114.67 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.92 / $105.78 / $114.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,064.98 / $1,241.27 / $1,681.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.78 / $83.72 / $167.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.20 / $99.20 / $361.12
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.99 / $2,056.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.41 / $105.99 / $137.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.26 / $101.40 / $144.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.00 / $1,209.00 / $2,029.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.90 / $115.29 / $155.86