go back

Missouri 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
$1,547.00 / $3,809.00 / $8,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.00 / $2,076.00 / $5,389.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.00 / $2,363.00 / $5,100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,216.00 / $2,261.00 / $3,074.00