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Oklahoma 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
$882.00 / $3,612.00 / $7,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,444.00 / $3,684.00 / $6,245.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,878.46 / $6,117.46 / $9,735.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $634.00 / $1,883.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.00 / $774.00 / $1,615.00