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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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.00 / $2,640.00 / $7,542.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $29.50 / $37.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.96 / $795.23 / $1,774.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $42.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $42.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $952.00 / $2,405.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $21.60