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Michigan rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$239.88 / $2,884.03 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $173.78 / $371.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $199.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $190.55 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $213.80 / $660.69
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $2,884.03 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $229.09 / $309.03
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $190.55 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,258.93 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $204.17 / $281.84