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Washington 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
$3,016.00 / $8,500.00 / $22,024.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,273.61 / $5,167.93 / $9,885.68
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.82 / $264.91 / $939.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.92 / $1,110.00 / $2,323.83
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.14 / $2,037.92 / $5,429.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $1,565.69 / $2,381.56
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,482.30 / $4,413.00 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.83 / $1,040.51 / $1,040.51
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,770.96 / $5,167.93 / $9,885.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.00 / $1,120.00 / $6,857.00