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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
$0.83 / $22.91 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $29.51 / $56.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $151.36 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $63.10 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $117.49 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $83.18 / $138.04
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $112.20 / $218.78
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $79.43 / $128.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $47.86 / $562.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $64.57 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,862.09 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $54.95 / $104.71