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North Carolina 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
$903.00 / $4,311.00 / $7,968.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $725.00 / $5,449.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.00 / $833.00 / $1,928.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00