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Texas rates for HCPCS C5271

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78