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Minnesota rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$64.57 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $109.65 / $218.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $426.58 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $213.80 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $478.63 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $275.42 / $537.03
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $457.09 / $891.25
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $257.04 / $467.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $151.36 / $389.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $257.04 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,862.09 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $186.21 / $398.11