go back

Arizona rates for HCPCS C5274

Application of low cost skin substitute graft to trunk, arms, legs, 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)

Facilitymedian $1,096 · 10th–90th $275–$2,0420%5%10th90th$1,096Professionalmedian $59 · 10th–90th $38–$1820%10%20%10th90th$59$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $1,230.27 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $58.88 / $181.97
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $1,122.02 / $2,041.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $707.95 / $1,584.89