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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
$98.73 / $169.50 / $4,828.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.73 / $159.40 / $261.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $86.39 / $935.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.04 / $312.35 / $566.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.71 / $607.97 / $1,462.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.24 / $398.17 / $726.16
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.43 / $555.83 / $1,151.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.71 / $368.12 / $684.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.31 / $210.51 / $425.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.63 / $360.89 / $1,775.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.63 / $312.19 / $674.10