go back

Pennsylvania 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 Additionto Code For Primary Procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.00 / $2,371.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,371.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $1,978.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $674.00 / $4,300.00