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Minnesota 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
$70.95 / $137.94 / $2,525.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $60.75 / $665.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.49 / $488.52 / $1,175.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.25 / $446.63 / $925.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.39 / $160.49 / $359.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00