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Iowa 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
$2,218.00 / $3,576.15 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,546.00 / $2,546.00 / $2,546.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,026.00 / $1,623.00 / $3,560.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $1,640.00 / $3,560.25