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Minnesota rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.35 / $31.21 / $2,168.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.35 / $31.21 / $49.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $20.14 / $214.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.18 / $62.97 / $108.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.33 / $111.08 / $267.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.56 / $80.19 / $137.46
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.68 / $101.56 / $210.41
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.80 / $74.01 / $126.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.26 / $46.02 / $83.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.68 / $67.45 / $2,210.02
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
$38.90 / $59.07 / $118.08