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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,119.00 / $3,119.00 / $17,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.00 / $4,677.24 / $6,312.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $65.00 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,976.00 / $4,155.00 / $5,865.00