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Arizona rates for HCPCS C5273

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.00 / $2,933.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,283.06 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.82 / $198.68 / $307.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $1,900.00 / $4,466.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,578.00 / $2,522.00 / $5,029.00