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Kentucky 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
$416.00 / $1,716.00 / $8,229.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.00 / $2,843.00 / $8,229.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.01 / $8.01 / $8.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.00 / $668.00 / $1,895.00