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Louisiana 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
$497.00 / $1,300.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.00 / $1,638.00 / $3,779.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $1.65 / $2.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $513.00 / $1,226.00