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Minnesota rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.43 / $156.46 / $2,525.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.55 / $141.53 / $265.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.62 / $2,868.68 / $6,480.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.90 / $282.02 / $514.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.71 / $562.58 / $1,353.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $356.91 / $676.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.37 / $514.33 / $1,065.64
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.70 / $339.85 / $629.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.91 / $209.11 / $2,735.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.60 / $299.11 / $3,179.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,296.00 / $3,500.00 / $6,361.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.54 / $275.33 / $539.75