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Arizona rates for HCPCS C5271

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,070.00 / $2,901.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $29.50 / $323.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.79 / $2,211.19 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.38 / $90.02 / $152.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $835.00 / $2,035.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00