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Kentucky 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
$557.00 / $2,200.00 / $8,229.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,014.00 / $4,516.00 / $5,018.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.01 / $8.01 / $8.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,081.00 / $4,081.00 / $4,081.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.00 / $1,450.00 / $4,039.00