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Louisiana 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
$580.00 / $1,544.00 / $3,779.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $2,698.00 / $3,779.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,937.39 / $3,603.62 / $6,382.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.00 / $1,429.00 / $4,010.00