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Pennsylvania 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
$1,013.00 / $2,954.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.00 / $1,575.67 / $5,958.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$934.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.00 / $1,659.00 / $7,197.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,391.00 / $6,000.00