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Alaska rates for HCPCS C5271

Application of low cost skin substitute graft to trunk, arms, legs, 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
$5,328.00 / $8,303.41 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $29.50 / $29.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $41.30 / $42.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $41.30 / $42.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $2,250,000.00 / $2,400,000.00