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Indiana 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
$927.00 / $4,846.00 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.00 / $1,575.67 / $1,575.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.00 / $5,820.00 / $8,388.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.83 / $1,314.83 / $1,314.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $3,870.00 / $5,490.00