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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 Surfacearea 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