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Virginia 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
$2,670.00 / $5,168.00 / $8,920.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $3,226.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $8.01
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $1,670.21 / $2,363.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.00 / $3,175.00 / $5,340.00