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Nevada 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
$911.00 / $1,713.00 / $4,473.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,706.00 / $3,605.00 / $10,300.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.00 / $1,427.00 / $1,998.00