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Nebraska 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
$3,034.03 / $6,048.00 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.00 / $1,556.10 / $11,100.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,387.57 / $8,486.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.08 / $3,047.38 / $7,934.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.64 / $1,765.96 / $2,305.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $3,726.00 / $7,934.00