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Minnesota rates for HCPCS C5273

Application of low cost skin substitute graft to trunk, arms, legs, 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
$1,590.00 / $2,525.00 / $3,638.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.00 / $1,539.00 / $2,843.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,370.01 / $4,415.14 / $7,374.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,523.00 / $4,410.56 / $6,051.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,296.00 / $3,500.00 / $6,361.00