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Kansas 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
$1,886.00 / $4,747.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.00 / $3,281.00 / $7,655.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.00 / $806.99 / $1,629.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.00 / $1,925.00 / $3,810.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.00 / $2,081.00 / $3,918.00