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Minnesota rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$97.72 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $147.91 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $660.69 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $309.03 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $645.65 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $407.38 / $724.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,202.26
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $380.19 / $691.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $223.87 / $446.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $346.74 / $1,778.28
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
$144.54 / $269.15 / $549.54