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Hawaii 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
$988.00 / $2,898.00 / $3,444.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,078.00 / $1,078.00