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Arkansas rates for HCPCS C5276

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; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.00 / $1,313.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.00 / $975.00 / $1,846.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $337.00 / $768.00