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North Carolina 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
$1,181.00 / $4,922.05 / $7,968.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.00 / $1,245.00 / $7,278.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,670.21 / $1,670.21 / $2,363.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,728.00 / $3,733.00 / $6,543.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00