go back

Idaho 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
$1,575.67 / $1,575.67 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,306.03 / $4,697.79 / $5,755.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00