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Wisconsin 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

Facilitymedian $4,677 · 10th–90th $3,020–$7,0790%10%10th90th$4,677Professionalmedian $65 · 10th–90th $55–$710%20%10th90th$65$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,677.35 / $7,079.46
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $4,265.80 / $6,309.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $4,265.80 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,019.95 / $7,244.36