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Minnesota rates for HCPCS C5277

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 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
$513.00 / $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
$816.22 / $1,396.23 / $2,539.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,438.00 / $1,749.00 / $2,720.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00