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Minnesota 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 Surfacearea 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
$2,042.00 / $2,168.00 / $3,119.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.00 / $1,023.00 / $2,843.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.00 / $1.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,720.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00