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Arizona rates for HCPCS C5275

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 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
$390.06 / $2,727.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $649.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,283.06 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.62 / $98.27 / $157.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $902.00 / $2,035.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00