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Wisconsin rates for HCPCS C5271

Application Of Low Cost Skin Substitute Graft To Trunk Arms Legs Total Wound Surface Area Up To 100 Sq Cm; First 25 Sq Cm Or Less Wound Surface Area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $29.50 / $323.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $29.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $1,239.00 / $2,090.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $65.00 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $29.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90