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Ohio 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
$548.78 / $3,696.00 / $11,581.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $323.98 / $323.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$937.00 / $1,927.00 / $3,943.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.01 / $8.01 / $8.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.00 / $1,513.00 / $1,513.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $975.00 / $2,914.00