go back

Iowa 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
$2,218.00 / $3,576.15 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,546.00 / $2,546.00 / $2,546.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.80 / $1,607.00 / $2,338.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.00 / $1,623.00 / $2,126.00