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Minnesota rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.05 / $334.19 / $2,525.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.05 / $323.81 / $517.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.98 / $3,109.26 / $6,480.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.54 / $619.44 / $1,123.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.47 / $1,177.71 / $2,833.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.10 / $771.42 / $1,415.72
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.11 / $1,076.71 / $2,230.83
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.51 / $715.86 / $1,330.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.51 / $432.71 / $1,022.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.65 / $653.64 / $1,622.24
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
$388.65 / $692.86 / $1,289.61