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Utah 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
$35.18 / $3,084.00 / $4,707.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $35.18 / $649.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$873.66 / $1,190.82 / $1,735.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00