go back

South Dakota 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
$3,073.00 / $3,073.00 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $2,662.88 / $4,317.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.64 / $1,716.91 / $2,364.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00