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Virginia 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
$1,346.00 / $4,796.00 / $8,920.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.00 / $2,582.00 / $5,042.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $8.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.00 / $833.00 / $2,375.00