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New York 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
$1,668.00 / $4,442.00 / $9,661.00
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
$1,691.00 / $3,382.00 / $4,707.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,071.00 / $2,071.00 / $6,213.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,207.51 / $4,207.51 / $4,207.51
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.00 / $2,826.00 / $4,851.00