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Minnesota rates for HCPCS C5275

Application of low cost 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
$27.58 / $27.58 / $2,525.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $27.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.22 / $1,396.23 / $2,539.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $1,438.00 / $2,400.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00