go back

Mississippi 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
$27.58 / $993.00 / $1,831.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $27.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.36 / $494.36 / $543.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.00 / $433.00 / $433.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.62 / $339.62 / $747.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $529.00 / $1,739.00