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Michigan rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.55 / $163.16 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,285.42 / $1,498.20 / $2,029.83
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.54 / $2,877.00 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $1,418.00 / $2,449.00