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Oregon rates for HCPCS C5272

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.00 / $6,629.40 / $8,728.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $36.00 / $77.40
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $37.79 / $77.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.00 / $3,290.00 / $6,216.00