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Arkansas rates for HCPCS C5274

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.00 / $1,313.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.00 / $975.00 / $1,846.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $328.00 / $858.00