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Washington 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
$29.50 / $6,623.55 / $20,680.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $29.50 / $323.98
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,016.89 / $1,779.82 / $3,404.60
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.38 / $130.94 / $292.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.44 / $777.59 / $1,110.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.56 / $681.92 / $1,723.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $523.90 / $796.91
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.44 / $1,520.00 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.51 / $350.25 / $350.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.58 / $1,778.80 / $3,404.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00