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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 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
$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