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Georgia rates for HCPCS C5272

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.50 / $3,391.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.80 / $8.01 / $8.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.34 / $98.34 / $98.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.00 / $1,580.00 / $2,665.00