go back

Arizona rates for HCPCS C5278

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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $891.25 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $66.07 / $107.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,412.54 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $707.95 / $1,584.89