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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