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Hawaii 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
$1,486.00 / $3,883.00 / $4,705.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $1,689.00 / $1,689.00