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Wisconsin 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)

Rates data updated July 2026.

Facilitymedian $1,445 · 10th–90th $891$2,3440%10%10th90th$1,445Professionalmedian $65 · 10th–90th $55$710%20%10th90th$65$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,445.44
Typical High
$2,089.30
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$933.25
Typical High
$2,344.23
United
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,698.24
Typical High
$3,981.07