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Arizona 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
$1,170.00 / $2,640.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,260.00 / $2,640.00 / $4,474.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.10 / $1,143.18 / $1,810.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $24.52 / $32.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,409.00 / $2,057.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.00 / $1,423.00 / $2,210.00