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Illinois rates for HCPCS C5275

Application Of Low Cost Skin Substitute Graft To Face Scalp Eyelids Mouth Neck Ears Orbits Genitalia Hands Feet And/Or Multiple Digits Total Wound Surface Area Up To 100 Sq Cm; First 25 Sq Cm Or Less Wound Surface Area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.00 / $1,848.00 / $5,389.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $649.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.57 / $893.34 / $1,129.43
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $150.00 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $1,032.00 / $3,686.00