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Rhode Island 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
$2,090.73 / $2,778.87 / $3,955.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,401.14 / $3,734.41 / $5,551.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,812.00 / $4,049.00 / $5,510.00