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Connecticut 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
$2,411.00 / $4,769.00 / $8,031.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $35.18 / $35.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,824.00 / $8,848.00 / $11,797.00
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
$416.49 / $416.49 / $416.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,347.00 / $3,983.00 / $6,832.00