go back

Kansas 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,629.00 / $3,600.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.00 / $2,624.00 / $7,655.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.00 / $526.00 / $1,713.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $550.00 / $1,769.00