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New York 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
$1,819.00 / $4,663.00 / $9,868.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $37.43 / $37.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.00 / $3,382.00 / $4,707.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,071.00 / $2,071.00 / $6,213.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.00 / $2,826.00 / $4,851.00