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Georgia rates for HCPCS C5278

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 greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.75 / $3,391.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,438.00 / $3,817.00 / $6,915.00
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